Provider Demographics
NPI:1366587099
Name:BOHANNON, ADRIENNE ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:ANN
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 POMEGRANITE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8970
Mailing Address - Country:US
Mailing Address - Phone:919-455-6667
Mailing Address - Fax:
Practice Address - Street 1:3209 POMEGRANITE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-8970
Practice Address - Country:US
Practice Address - Phone:919-455-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist