Provider Demographics
NPI:1629556378
Name:ABBONIZIO, BROOKE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ABBONIZIO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BROWN ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2952
Mailing Address - Country:US
Mailing Address - Phone:856-905-4399
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD STE 220
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2793
Practice Address - Country:US
Practice Address - Phone:215-646-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJW216188477OtherAETNA