Provider Demographics
NPI:1952431140
Name:BRACCHI, AUDREY ELLEN (MA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELLEN
Last Name:BRACCHI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 CAYENTE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2936
Mailing Address - Country:US
Mailing Address - Phone:916-483-3302
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD FL 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-4191
Practice Address - Fax:916-457-8214
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1479231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist