Provider Demographics
NPI:1801671128
Name:BRYANT, FAATIN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:FAATIN
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 CONCORD TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7063
Mailing Address - Country:US
Mailing Address - Phone:216-551-3731
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR AVE E STE 1800
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2500
Practice Address - Country:US
Practice Address - Phone:216-838-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty