Individual
BRANTLEY BLACK BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
437 OLD PEACHTREE RD NW, SUWANEE, GA 30024-2978
(678) 301-6000
Mailing address
4370 LAUREL GROVE TRCE, SUWANEE, GA 30024-6930
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14173439
—
Other
Enumeration date
04/03/2025
Last updated
04/03/2025
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