Provider Demographics
NPI:1750873147
Name:BRAND, ALICIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:CARLSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-321-4898
Mailing Address - Fax:
Practice Address - Street 1:2127 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-321-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-5326235Z00000X
IDSLP-5800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist