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General NPI Number Information
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NPI Number | 1730413733
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Entity Type | Individual
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Provider Name | SOTHEARY BRANDON CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 708 HELEN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5713
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Country | US
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Telephone | 832-693-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 708 HELEN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5713
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Country | US
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Telephone | 832-693-0082
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3394
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5975
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License Number State | LA
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