MEDICARE: MRS. BRANDI M PERKINS 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	1673	AR

General Provider Information

NPI Number	:	1790936417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI M PERKINS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	101 S PROSPECT ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-3045
Country	:	US
Telephone Number	:	479-524-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S MAPLE ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4147
Country	:	US
Telephone Number	:	479-524-8130
Fax Number	:

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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Directions to “ MRS. BRANDI M PERKINS M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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