=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972493740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAINTHRIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 REBECCA CT
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30215-2769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-841-3062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 REBECCA CT
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30215-2769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-841-3062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANE HUTCHINSON
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 770-841-3062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------