Provider Demographics
NPI:1972884567
Name:AVERA, BRITTANY DIANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:DIANE
Last Name:AVERA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BATTERY AVE SE UNIT 339
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2941
Mailing Address - Country:US
Mailing Address - Phone:678-813-8751
Mailing Address - Fax:
Practice Address - Street 1:900 BATTERY AVE SE UNIT 339
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2941
Practice Address - Country:US
Practice Address - Phone:678-813-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11122235Z00000X
GASLP007787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist