Provider Demographics
NPI:1679946693
Name:BRUNSON, DEVON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4115 MCCAMEY DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6298
Mailing Address - Country:US
Mailing Address - Phone:301-801-4875
Mailing Address - Fax:
Practice Address - Street 1:4115 MCCAMEY DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-6298
Practice Address - Country:US
Practice Address - Phone:301-801-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist