Provider Demographics
NPI:1699820076
Name:RISNER, BRANDY (SLP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:RISNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-208-8989
Mailing Address - Fax:
Practice Address - Street 1:2915 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5008
Practice Address - Country:US
Practice Address - Phone:870-535-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSPP7976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist