Provider Demographics
NPI:1558156828
Name:PRICE, BREANNA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:PRICE
Suffix:
Gender:
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E GAINES ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6157
Mailing Address - Country:US
Mailing Address - Phone:478-595-0317
Mailing Address - Fax:888-249-2172
Practice Address - Street 1:113 E GAINES ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6157
Practice Address - Country:US
Practice Address - Phone:478-595-0317
Practice Address - Fax:888-249-2172
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist