Provider Demographics
NPI:1669754396
Name:MOBLEY, BRANDY J (MED)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:J
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 W DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3991
Mailing Address - Country:US
Mailing Address - Phone:386-755-9919
Mailing Address - Fax:386-752-9244
Practice Address - Street 1:359 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3991
Practice Address - Country:US
Practice Address - Phone:386-755-9919
Practice Address - Fax:386-752-9244
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist