Healthcare Provider Details

I. General information

NPI: 1871402669
Provider Name (Legal Business Name): BREANNA BYRD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2118 SANDY LN
LAUREL MS
39443-9087
US

IV. Provider business mailing address

2118 SANDY LN
LAUREL MS
39443-9087
US

V. Phone/Fax

Practice location:
  • Phone: 601-342-2923
  • Fax: 601-255-8623
Mailing address:
  • Phone: 601-342-2923
  • Fax: 601-255-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5580
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: