Provider Demographics
NPI:1497646830
Name:WARD, BREANNA NICOLE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICOLE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 RIVERCHESS DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6016
Mailing Address - Country:US
Mailing Address - Phone:404-434-4538
Mailing Address - Fax:
Practice Address - Street 1:10917 HIGHWAY 92 STE 130&140
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6329
Practice Address - Country:US
Practice Address - Phone:678-447-1617
Practice Address - Fax:678-735-7505
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist