Provider Demographics
NPI:1306408331
Name:CHISHOLM, BRITTANY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:CHISHOLM
Other - Last Name:PROFANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1201 FITZWATER ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1844
Mailing Address - Country:US
Mailing Address - Phone:215-805-1473
Mailing Address - Fax:
Practice Address - Street 1:720 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1313
Practice Address - Country:US
Practice Address - Phone:215-882-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist