Healthcare Provider Details

I. General information

NPI: 1902576432
Provider Name (Legal Business Name): BREANNA CIPPONERI CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 COMMERCE RD
WEST BLOOMFIELD MI
48324-2717
US

IV. Provider business mailing address

6611 COMMERCE RD
WEST BLOOMFIELD MI
48324-2717
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-1221
  • Fax:
Mailing address:
  • Phone: 248-266-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101007938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: