Provider Demographics
NPI:1114644200
Name:GROEGER, BRIANA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNN
Last Name:GROEGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WEKIVA WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2453
Mailing Address - Country:US
Mailing Address - Phone:386-697-6174
Mailing Address - Fax:
Practice Address - Street 1:1333 WEKIVA WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2453
Practice Address - Country:US
Practice Address - Phone:386-697-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist