Provider Demographics
NPI:1942536800
Name:BRANHAM, CHARLOTTE JUNE (MS, CCC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JUNE
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 SPOKANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-9793
Mailing Address - Country:US
Mailing Address - Phone:406-475-3112
Mailing Address - Fax:
Practice Address - Street 1:2778 SPOKANE CREEK RD
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-9793
Practice Address - Country:US
Practice Address - Phone:406-475-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist