Provider Demographics
NPI:1841971538
Name:MCINTOSH, BREANNA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:MCINTOSH
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 1:462 N GUIGNARD DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4029
Mailing Address - Country:US
Mailing Address - Phone:803-774-7783
Mailing Address - Fax:893-774-7785
Practice Address - Street 1:462 N GUIGNARD DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4029
Practice Address - Country:US
Practice Address - Phone:803-774-7783
Practice Address - Fax:893-774-7785
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist