Provider Demographics
NPI:1346596467
Name:BRANNAN, STEFANIE LEE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LEE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:LEE
Other - Last Name:SOTELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1431 FRAUN CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9320
Mailing Address - Country:US
Mailing Address - Phone:775-742-8635
Mailing Address - Fax:775-448-6106
Practice Address - Street 1:1431 FRAUN CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-9320
Practice Address - Country:US
Practice Address - Phone:775-742-8635
Practice Address - Fax:775-448-6106
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist