Provider Demographics
NPI:1336560473
Name:HARDEE, BRANDI (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:
Last Name:HARDEE
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 1:34048 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5041
Mailing Address - Country:US
Mailing Address - Phone:813-363-5183
Mailing Address - Fax:
Practice Address - Street 1:34048 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33543-5041
Practice Address - Country:US
Practice Address - Phone:813-363-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA 12603OtherDEPARTMENT OF HEALTH LICENSE
FL012440600Medicaid