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Individual
MRS. MIRIAM AMANDA BRANHAM
Active
Individual
MRS. MIRIAM AMANDA BRANHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17043
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
528357
BCBS PROVIDER NUMBER
TX
01
—
75-06582802
TAX ID NUMBER
TX
Enumeration date
08/03/2006
Last updated
05/20/2022
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