Individual
BREANNA SUZANNE FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
100 AKAHELE ST, LAHAINA, HI 96761-9395
(808) 662-3955
Mailing address
3626 LOWER HONOAPIILANI RD APT C302, LAHAINA, HI 96761-8992
(610) 716-7009
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
O1-0001777
DE
Other
Enumeration date
09/20/2019
Last updated
07/07/2024
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