Healthcare Provider Details

I. General information

NPI: 1992152318
Provider Name (Legal Business Name): BRITTANY ESCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY MAPLES

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 TOTEROS DR
WAXHAW NC
28173-6950
US

IV. Provider business mailing address

1229 TOTEROS DR
WAXHAW NC
28173-6950
US

V. Phone/Fax

Practice location:
  • Phone: 704-649-4509
  • Fax: 704-843-9045
Mailing address:
  • Phone: 704-649-4509
  • Fax: 704-843-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP23322
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30001322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: