Provider Demographics
NPI:1215626239
Name:BRANNMAN, JEAN LOUISE (MED, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:LOUISE
Last Name:BRANNMAN
Suffix:
Gender:F
Credentials:MED, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 FORT HUNT CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1915
Mailing Address - Country:US
Mailing Address - Phone:619-309-5855
Mailing Address - Fax:
Practice Address - Street 1:1609 FORT HUNT CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1915
Practice Address - Country:US
Practice Address - Phone:619-309-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty