Provider Demographics
NPI:1780008417
Name:STEFANIE BRANNAN M.S. CCC-SLP
Entity Type:Organization
Organization Name:STEFANIE BRANNAN M.S. CCC-SLP
Other - Org Name:NEVADA SPEECH AND THERAPY GROUP - SPARKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:775-742-8635
Mailing Address - Street 1:4940 SAN DIEGO CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0687
Mailing Address - Country:US
Mailing Address - Phone:775-742-8635
Mailing Address - Fax:775-448-6106
Practice Address - Street 1:4940 SAN DIEGO CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-0687
Practice Address - Country:US
Practice Address - Phone:775-742-8635
Practice Address - Fax:775-448-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty