Provider Demographics
NPI:1639383987
Name:BRANT, BETH ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BRANT
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 1:1708 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6642
Mailing Address - Country:US
Mailing Address - Phone:757-641-6388
Mailing Address - Fax:
Practice Address - Street 1:820 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1034
Practice Address - Country:US
Practice Address - Phone:757-641-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist