Individual
BREANNE BARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
904 DREXEL ST, DEARBORN, MI 48128-1641
(248) 755-8749
Mailing address
904 DREXEL ST, DEARBORN, MI 48128-1641
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101002116
MI
235Z00000X
Speech-Language Pathologist
710100216
MI
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101002116
—
MI
Enumeration date
12/18/2018
Last updated
12/18/2018
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