Provider Demographics
NPI:1558811067
Name:BRODERICK, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRODERICK
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 1:234 GOODMAN ST
Mailing Address - Street 2:AREA F
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-475-8400
Mailing Address - Fax:513-475-8228
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 5200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8400
Practice Address - Fax:513-475-8228
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist