Provider Demographics
NPI:1275044620
Name:ALLEN BRICKMAN, PATRICIA LEE (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LEE
Last Name:ALLEN BRICKMAN
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:W379N5782 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2265
Mailing Address - Country:US
Mailing Address - Phone:262-444-3224
Mailing Address - Fax:
Practice Address - Street 1:2840 NW 2ND AVE STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6692
Practice Address - Country:US
Practice Address - Phone:800-233-5976
Practice Address - Fax:888-238-3365
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI666-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist