Provider Demographics
NPI:1821733940
Name:PEARSON, BRANDON (SLP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 GRAYCREEK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1975
Mailing Address - Country:US
Mailing Address - Phone:865-771-3931
Mailing Address - Fax:
Practice Address - Street 1:804 SHANNONDALE WAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-5970
Practice Address - Country:US
Practice Address - Phone:865-982-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist