Provider Demographics
NPI:1871013094
Name:BRYAN, KORI ANN MITCHELL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:ANN MITCHELL
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:ANN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2472 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3768
Mailing Address - Country:US
Mailing Address - Phone:906-635-4426
Mailing Address - Fax:906-635-4610
Practice Address - Street 1:2472 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3768
Practice Address - Country:US
Practice Address - Phone:906-635-4426
Practice Address - Fax:906-635-4610
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist