Vanessa Trina Bravo, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Chesterton, IN
NPI 1760102909 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1760102909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22006848A (IN)
- Practice address
- 383 Kingsmill Dr
Chesterton, IN 46304-2266 - Phone
- (219) 798-2655
- NPI assigned
- Aug 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221014001345 | IN | Practitioner - Qualified Speech Language Pathologist | 6305212432 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duneland Speech Solutions LLC | Single Specialty | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | 22006848A | IN | Yes |
Addresses
Primary practice location
383 Kingsmill Dr
Chesterton, IN 46304-2266
Mailing address
383 Kingsmill Dr
Chesterton, IN 46304-2266
Phone (219) 798-2655
Other providers in Chesterton, IN
- Amy Bowman
- Aaniyah Boyd
- Cheryl Brady
- John Patrick Brady
- Katherine Brankin
- Kendra Nicole Brazier
- Ma Carmel Quijada Breidigan
- Joseph Brett
- Benjamin Brewer
- Brian C. McGue DDS PC
All providers in Chesterton, IN · Speech-Language Pathologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.