Provider Demographics
NPI:1538396734
Name:BRANNEMAN, SHANDA KAYE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:KAYE
Last Name:BRANNEMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 FALCON BROOK CT
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:IN
Mailing Address - Zip Code:46553-9233
Mailing Address - Country:US
Mailing Address - Phone:574-831-6173
Mailing Address - Fax:
Practice Address - Street 1:20400 FALCON BROOK CT
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:IN
Practice Address - Zip Code:46553-9233
Practice Address - Country:US
Practice Address - Phone:574-831-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003431A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist