Healthcare Provider Details

I. General information

NPI: 1952941429
Provider Name (Legal Business Name): BRIANA HURLEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANA AUDREY PALLAS

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 INFIELD CT
MOORESVILLE NC
28117-8026
US

IV. Provider business mailing address

134 INFIELD CT
MOORESVILLE NC
28117-8026
US

V. Phone/Fax

Practice location:
  • Phone: 704-799-6824
  • Fax: 704-799-6825
Mailing address:
  • Phone: 704-799-6824
  • Fax: 704-799-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14217
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number029419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: