Provider Demographics
NPI:1508375882
Name:BRANNON, CAROLINE FRALEY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:FRALEY
Last Name:BRANNON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELIZABETH ST.
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023
Mailing Address - Country:US
Mailing Address - Phone:704-692-5758
Mailing Address - Fax:
Practice Address - Street 1:120 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-3103
Practice Address - Country:US
Practice Address - Phone:704-692-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty