Healthcare Provider Details

I. General information

NPI: 1487191771
Provider Name (Legal Business Name): JENNA LEIGH BRANT M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 VERREE RD
PHILADELPHIA PA
19111-1370
US

IV. Provider business mailing address

4312 MAIN ST APT 207
PHILADELPHIA PA
19127-1530
US

V. Phone/Fax

Practice location:
  • Phone: 215-214-2800
  • Fax:
Mailing address:
  • Phone: 814-715-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP009292
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL013470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: