MEDICARE: CANDICE B BRANNAN

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

General Provider Information

NPI Number	:	1588441091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE B BRANNAN

Provider Business Mailing Address
First Line	:	206 QUINCE CT
Second Line	:
City	:	HOLLIDAYSBURG
State	:	PA
Zip	:	16648-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E MAIN ST
Second Line	:
City	:	ROARING SPRING
State	:	PA
Zip	:	16673-1633
Country	:	US
Telephone Number	:	814-224-5124
Fax Number	:

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

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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Directions to “ CANDICE B BRANNAN ” Practice Location

Language	Start Address	Practice Location

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