Basic Information
| Provider Information | |||||||||
| NPI: | 1275871162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POALILLO MCSWEAN | ||||||||
| FirstName: | BREANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | POALILLO | ||||||||
| OtherFirstName: | BREANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319092741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Practice Location | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319092741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PCET001867 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.