Basic Information
| Provider Information | |||||||||
| NPI: | 1174967384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANNON | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LYNEE' | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRANNON | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1501 TAYLOR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984214100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533021624 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Practice Location | |||||||||
| Address1: | 6712 KIMBALL DR | ||||||||
| Address2: | STE. 103 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533021624 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2013 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG 60128134 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.