MEDICARE: MARIANNE BRAWNER MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	104608	TX

General Provider Information

NPI Number	:	1104468156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE BRAWNER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4216 SARITA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4746
Country	:	US
Telephone Number	:	817-637-7605
Fax Number	:

Provider Business Practice Location Address
First Line	:	4216 SARITA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4746
Country	:	US
Telephone Number	:	817-637-7605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	10/10/2019

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