Provider Demographics
NPI:1881427938
Name:GUYETTE, BRANDI LEA
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEA
Last Name:GUYETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEA
Other - Last Name:VANBROCKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1017 TRIPLE CROWN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-2326
Mailing Address - Country:US
Mailing Address - Phone:817-729-3367
Mailing Address - Fax:
Practice Address - Street 1:1017 TRIPLE CROWN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-2326
Practice Address - Country:US
Practice Address - Phone:817-729-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373592355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant