Provider Demographics
NPI:1740613298
Name:BRUKHMAN, CARLY WEINREB (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:WEINREB
Last Name:BRUKHMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:MICHELLE
Other - Last Name:WEINREB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1701 NE COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7921
Mailing Address - Country:US
Mailing Address - Phone:206-616-2754
Mailing Address - Fax:
Practice Address - Street 1:8804 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5902
Practice Address - Country:US
Practice Address - Phone:718-238-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist