Brantley Black Bruce, CCC-SLP
Speech-Language Pathologist, in Suwanee, GA. Individual provider (NPI-1).
NPI number1407650708
StatusActive
Last updated in NPPESApr 3, 2025
Details
- NPI
- 1407650708
- Entity type
- Individual (NPI-1)
- Name
- Brantley Black Bruce
- Credential
- CCC-SLP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 3, 2025
- Certification date
- Apr 3, 2025
- Last updated
- Apr 3, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 14173439 | – | Yes |
Other names
- Brantley Black (Former Name)
Practice location
437 Old Peachtree Rd NwSuwanee, GA 30024-2978
Phone 678-301-6000
Mailing address
4370 Laurel Grove TrceSuwanee, GA 30024-6930
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