Provider Demographics
NPI:1790203065
Name:TONEY, BREANNE MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:MARIE
Last Name:TONEY
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 1:19814 23RD DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7607
Mailing Address - Country:US
Mailing Address - Phone:206-909-2650
Mailing Address - Fax:
Practice Address - Street 1:127 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2515
Practice Address - Country:US
Practice Address - Phone:253-216-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WA60877449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14297364OtherASHA LICENSE
WALL60877449OtherSTATE SLP LICENSE