Provider Demographics
NPI:1477265841
Name:BRYNER, BLYTHE NICOLE
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:NICOLE
Last Name:BRYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 UNITY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-1852
Mailing Address - Country:US
Mailing Address - Phone:412-592-6403
Mailing Address - Fax:
Practice Address - Street 1:3901 DENFELD AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1510
Practice Address - Country:US
Practice Address - Phone:240-740-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist