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General NPI Number Information
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NPI Number | 1174967384
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Entity Type | Individual
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Provider Name | SANDRA LYNEE' BRANNON M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 6712 KIMBALL DR STE. 103
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City | GIG HARBOR
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State | WA
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Zip | 98335-1212
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Country | US
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Telephone | 253-302-1624
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Fax | 253-858-2254
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Provider Business Mailing Address
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Address Line | 1501 TAYLOR WAY
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City | TACOMA
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State | WA
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Zip | 98421-4100
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Country | US
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Telephone | 253-302-1624
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Fax | 253-858-2254
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG 60128134
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License Number State | WA
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