MEDICARE: BRANDI BOSMAN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	8247	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972120269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI BOSMAN CCC-SLP

Provider Business Mailing Address
First Line	:	10241 KINGSTON PIKE STE 3
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:
Fax Number	:	865-381-1919

Provider Business Practice Location Address
First Line	:	10241 KINGSTON PIKE STE 3
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:	865-851-9192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	11/01/2023

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Directions to “ BRANDI BOSMAN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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