Doctor Name: | MR. BRANDON SOOTS |
NPI Number: | 1932506078 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. CCC-SLP |
License Number: | 22004963A |
Business Practice Address: | 5810 E County Road 100 N Avon, IN - 461238621 |
Business Phone Number: | 7657302619 |
Business Fax Number: | |
Mailing Address: | 5810 E County Road 100 N, AVON |
State: | IN |
Postal Code: | 461238621 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/03/2014 |
NPI Last Update Date: | 12/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22004963A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |