Provider Demographics
NPI:1578755906
Name:BROTHERTON, NATALIE JANE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JANE
Last Name:BROTHERTON
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 1:7950 E STARLIGHT WAY
Mailing Address - Street 2:#114
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6146
Mailing Address - Country:US
Mailing Address - Phone:480-710-8351
Mailing Address - Fax:
Practice Address - Street 1:875 S COOPER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7581
Practice Address - Country:US
Practice Address - Phone:480-456-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA75292355S0801X
AZSLPL4643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist