Provider Demographics
NPI:1508496886
Name:BRADY, LOIS JEAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:JEAN
Last Name:BRADY
Suffix:
Gender:F
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 1:649 MAIN ST # 229
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1137
Mailing Address - Country:US
Mailing Address - Phone:925-812-0037
Mailing Address - Fax:
Practice Address - Street 1:195 GLEN COVE MARINA RD E STE 200
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7291
Practice Address - Country:US
Practice Address - Phone:707-651-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist