Healthcare Provider Details

I. General information

NPI: 1073448023
Provider Name (Legal Business Name): BRIANNA JULIETA CENTENO SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E FIR ST
MOUNT VERNON WA
98273-2971
US

IV. Provider business mailing address

2110 FOWLER ST
MOUNT VERNON WA
98274-8715
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-6131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA.SP.61340110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: