Individual
MADISON LAUREN BRAZEEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2625 N 19TH ST, BISMARCK, ND 58503-0574
(701) 222-3175
(701) 222-3186
Mailing address
2625 N 19TH ST, BISMARCK, ND 58503-0574
(701) 222-3175
(701) 222-3186
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-18-64141
CA
235Z00000X
Speech-Language Pathologist
Primary
1947
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1483045
—
ND
Enumeration date
08/30/2018
Last updated
04/19/2022
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