Healthcare Provider Details

I. General information

NPI: 1427937135
Provider Name (Legal Business Name): BRIANNE NICHOLE SMITH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 BUTTE AVE
SAN RAMON CA
94583-3531
US

IV. Provider business mailing address

3018 BUTTE AVE
SAN RAMON CA
94583-3531
US

V. Phone/Fax

Practice location:
  • Phone: 619-922-0862
  • Fax:
Mailing address:
  • Phone: 619-922-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: