NPI | 1720169774 |
---|---|
Former Name | MONICA BROADNAX |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202009158) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 7457) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2019-11-04 |