Individual
BREANNA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
Mailing address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(703) 217-9331
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004803
VA
Other
Enumeration date
03/27/2006
Last updated
06/15/2021
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