Provider Demographics
NPI:1942717566
Name:ISREAL, BRIANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:ISREAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 COAL MINE AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3919
Mailing Address - Country:US
Mailing Address - Phone:561-542-3723
Mailing Address - Fax:
Practice Address - Street 1:3025 COAL MINE AVE APT 7B
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3919
Practice Address - Country:US
Practice Address - Phone:561-542-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist