Provider Demographics
NPI:1093167033
Name:TILLMAN, BRITTANIE A (SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:A
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3780
Mailing Address - Country:US
Mailing Address - Phone:443-809-4554
Mailing Address - Fax:
Practice Address - Street 1:14500 BUSTLETON AVE STE 1A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1188
Practice Address - Country:US
Practice Address - Phone:215-613-6523
Practice Address - Fax:215-613-6527
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012659235Z00000X
MD10035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10035OtherMARYLAND DEPT. OF HEALTH- STATE BOARD EXAMINERS FOR AUD. SLP & MUSIC THERAPISTS