Provider Demographics
NPI:1437682929
Name:GREEN, BRITTANY (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4936
Mailing Address - Country:US
Mailing Address - Phone:814-836-3300
Mailing Address - Fax:
Practice Address - Street 1:4850 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4936
Practice Address - Country:US
Practice Address - Phone:814-836-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist