Provider Demographics
NPI:1629762505
Name:BRANNON, CARLEI (MS, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARLEI
Middle Name:
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WALL ST STE 8
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-5603
Mailing Address - Country:US
Mailing Address - Phone:318-805-1236
Mailing Address - Fax:318-404-1520
Practice Address - Street 1:404 WALL ST STE 8
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-5603
Practice Address - Country:US
Practice Address - Phone:318-370-9746
Practice Address - Fax:318-404-1520
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist