MEDICARE: MRS. SHANDA KAYE BRANNEMAN M.A. 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	22003431A	IN

General Provider Information

NPI Number	:	1538396734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANDA KAYE BRANNEMAN M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	20400 FALCON BROOK CT
Second Line	:
City	:	NEW PARIS
State	:	IN
Zip	:	46553-9233
Country	:	US
Telephone Number	:	574-831-6173
Fax Number	:

Provider Business Practice Location Address
First Line	:	20400 FALCON BROOK CT
Second Line	:
City	:	NEW PARIS
State	:	IN
Zip	:	46553-9233
Country	:	US
Telephone Number	:	574-831-6173
Fax Number	:

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

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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Directions to “ MRS. SHANDA KAYE BRANNEMAN M.A. CCC-SLP” Practice Location

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