Provider Demographics
NPI:1205103157
Name:BRASWELL, JOANNA W (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:W
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-5828
Mailing Address - Country:US
Mailing Address - Phone:229-209-1293
Mailing Address - Fax:229-732-6976
Practice Address - Street 1:106 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-5828
Practice Address - Country:US
Practice Address - Phone:229-209-1293
Practice Address - Fax:229-732-6976
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist