Provider Demographics
NPI:1407917677
Name:BRANSCUM, TRAEANNE (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRAEANNE
Middle Name:
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:TRAE
Other - Middle Name:
Other - Last Name:BRANSCUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:110 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:ARKOMA
Mailing Address - State:OK
Mailing Address - Zip Code:74901-3924
Mailing Address - Country:US
Mailing Address - Phone:479-420-7465
Mailing Address - Fax:
Practice Address - Street 1:108 HIGHWAY 71 N STE 114
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-5046
Practice Address - Country:US
Practice Address - Phone:479-209-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist