Healthcare Provider Details

I. General information

NPI: 1295645729
Provider Name (Legal Business Name): BRIELLE DAZEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 N MAIN ST
FRANKLIN IN
46131-1251
US

IV. Provider business mailing address

523 S MADISON AVE UNIT E207
GREENWOOD IN
46142-0598
US

V. Phone/Fax

Practice location:
  • Phone: 181-234-3279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14500506
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: