Provider Demographics
NPI:1396831335
Name:HUMPHREY, BRIAN D (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:HUMPHREY
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 1:3301 COLLEGE AVE
Mailing Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY - SLCD
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7721
Mailing Address - Country:US
Mailing Address - Phone:954-262-7726
Mailing Address - Fax:954-262-2847
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY - SLCD
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7721
Practice Address - Country:US
Practice Address - Phone:954-262-7705
Practice Address - Fax:954-262-2847
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist