Provider Demographics
NPI:1366272783
Name:BRANDT, JIANA MARIE (MS)
Entity type:Individual
Prefix:
First Name:JIANA
Middle Name:MARIE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MOUNT OLYMPUS AVE SE APT 1
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-9270
Mailing Address - Country:US
Mailing Address - Phone:707-239-3576
Mailing Address - Fax:
Practice Address - Street 1:915 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1006
Practice Address - Country:US
Practice Address - Phone:360-532-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist