Provider Demographics
NPI:1356579320
Name:BRASHER, ANGIE DAWN (SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:DAWN
Last Name:BRASHER
Suffix:
Gender:F
Credentials: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 MALLARD PT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7541
Mailing Address - Country:US
Mailing Address - Phone:731-512-0246
Mailing Address - Fax:
Practice Address - Street 1:727 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1924
Practice Address - Country:US
Practice Address - Phone:731-968-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist