Individual provider Active NPI

Cynthia S Brannon, CCC SLP

  • Speech-Language Pathologist
  • Mesa, AZ
National Provider Identifier
1386764470
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP1421 Issued in AZ
Practice address
108 W University Dr
Mesa, AZ 85201-5818
Phone
(480) 668-1917
Fax
(480) 668-2750
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP1421 AZ Primary

Addresses

Primary practice location

108 W University Dr
Mesa, AZ 85201-5818

Mailing address

10793 N 113TH St
Scottsdale, AZ 85259-4037
Phone (602) 686-3840

Other identifiers 1

IdentifierTypeStateIssuer
477671MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170130001896 AZ Practitioner - Qualified Speech Language Pathologist 8022390913 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Therapy One PLLCGroup PAC ID 2668771015, 5 clinicians

Practice addresses (Care Compare)

108 W University Dr
Mesa, AZ 85201-5818
Phone 4806681917405

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SLP1421AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mentis Reo, LLC. CurrentSince Aug 18, 2022 Accepting new patients
Advanced Therapy Solutions, LLC CurrentSince Aug 18, 2022 Accepting new patients
Pioneer Pet, LLC Past Accepting new patients
Solace Pediatric Healthcare Therapy Services Az, Inc. Speech-Language Pathologist PastSince Jan 1, 1995 Accepting new patients

Locations

690 E Warner Rd
Ste 105
Gilbert, AZ 85296
Phone (480) 820-6366

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1386764470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10793 N 113TH ST",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852594037",
            "telephone_number": "602-686-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W UNIVERSITY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852015818",
            "telephone_number": "480-668-1917",
            "fax_number": "480-668-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANNON",
        "first_name": "CYNTHIA",
        "middle_name": "S",
        "credential": "CCC SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP1421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "477671",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.