Provider Demographics
NPI:1700477791
Name:WILEY, BRYANNA LINDA
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:LINDA
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E BELL DE MAR DR APT 246N
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5742
Mailing Address - Country:US
Mailing Address - Phone:928-446-1849
Mailing Address - Fax:
Practice Address - Street 1:34179 N PICKET POST DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6649
Practice Address - Country:US
Practice Address - Phone:480-710-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA128542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant