Provider Demographics
NPI:1619503992
Name:SINNETT, BRYCE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:SINNETT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 DURAND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4961
Mailing Address - Country:US
Mailing Address - Phone:262-497-7270
Mailing Address - Fax:262-456-2387
Practice Address - Street 1:6233 DURAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-497-7270
Practice Address - Fax:262-456-2387
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4800-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4800-154OtherWISCONSIN STATE LICENSE