Individual
MRS. BRANDI MARISA BAZEMORE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
508 GENTILLY RD, STATESBORO, GA 30458-5149
(912) 681-7768
Mailing address
508 GENTILLY RD, STATESBORO, GA 30458-5149
(912) 681-7768
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP009766
GA
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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