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MRS. PENNY WICKHAM BRODIE CCC-SLP

>> Speech-Language Pathologist >> Speech, Language and Hearing Service Providers

Registrant NPI Number: 1902102551

Individual Registrant:
MRS. PENNY  WICKHAM BRODIE CCC-SLP
Gender: F
Sole Proprietor

Location and contact information for practice:
22 TANNERY RD  FORESTBURGH, NY 12777-6100 US
Tel: 845-707-4936  Fax: --

Contact information for business:
22 SAINT JOHN ST  MONTICELLO, NY 12701-2118 US
Tel: 845-794-4020  Fax: --

Registration Information:
NPI: 1902102551
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y235Z00000XSpeech, Language and Hearing Service Providers
Speech-Language Pathologist
NY0007772-1

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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