Doctor Name: | TRACIE RHODEN BRAZELL |
NPI Number: | 1497781306 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA-CCC-SLP |
License Number: | SLP005513 |
Business Practice Address: | 43 Aviary Ln Johnston, SC - 298322658 |
Business Phone Number: | 8032753767 |
Business Fax Number: | |
Mailing Address: | 43 Aviary Ln, JOHNSTON |
State: | SC |
Postal Code: | 298322658 |
Phone Number: | 8032753767 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP005513 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |