Provider Demographics
NPI:1972054302
Name:BRANSON, BRIANNA (MS)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 CASCADE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAGLETOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74734-3408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:WICKES
Practice Address - State:AR
Practice Address - Zip Code:71973-9312
Practice Address - Country:US
Practice Address - Phone:870-557-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P9075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist