Provider Demographics
NPI:1427690320
Name:POOL, BREANN TNAE (ST)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:TNAE
Last Name:POOL
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:TNAE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8726 LUPINE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1189
Mailing Address - Country:US
Mailing Address - Phone:806-331-6084
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD STE 137
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6406
Practice Address - Country:US
Practice Address - Phone:806-331-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14036703OtherLICENSE