Provider Demographics
NPI:1922154855
Name:BRANDON, TERRY LYNN
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 ROLLING PINE CIR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5507
Mailing Address - Country:US
Mailing Address - Phone:662-895-0049
Mailing Address - Fax:
Practice Address - Street 1:1536 APPLING CARE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4927
Practice Address - Country:US
Practice Address - Phone:901-385-1803
Practice Address - Fax:901-385-1817
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist