Provider Demographics
NPI:1437482379
Name:CORDERO, BRIONA (MSCCC/SLP)
Entity Type:Individual
Prefix:
First Name:BRIONA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MSCCC/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 844
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-0844
Mailing Address - Country:US
Mailing Address - Phone:570-269-1170
Mailing Address - Fax:
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-9975
Practice Address - Fax:570-839-3395
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394532OtherMEDICARE