Provider Demographics
NPI:1356480321
Name:EPPLEY, BROCK D (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BROCK
Middle Name:D
Last Name:EPPLEY
Suffix:
Gender:M
Credentials:MA 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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:814-506-8212
Mailing Address - Fax:814-506-8213
Practice Address - Street 1:403 6TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1518
Practice Address - Country:US
Practice Address - Phone:814-506-8212
Practice Address - Fax:814-506-8213
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist