Provider Demographics
NPI:1346486453
Name:BRODHEAD, ERIN KATE (MSED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATE
Last Name:BRODHEAD
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 PLATTEKILL ARDONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5035
Mailing Address - Country:US
Mailing Address - Phone:845-926-7415
Mailing Address - Fax:
Practice Address - Street 1:12 FRONT ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5622
Practice Address - Country:US
Practice Address - Phone:845-566-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58015900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist