Provider Demographics
NPI:1811556061
Name:BROADFIELD SPEECH & SWALLOWING THERAPY LLC
Entity Type:Organization
Organization Name:BROADFIELD SPEECH & SWALLOWING THERAPY LLC
Other - Org Name:BONNIE BROADFIELD WHITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:BROADFIELD
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:540-216-0078
Mailing Address - Street 1:2422 POCOSON WOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8313
Mailing Address - Country:US
Mailing Address - Phone:540-216-0078
Mailing Address - Fax:
Practice Address - Street 1:2422 POCOSON WOOD CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8313
Practice Address - Country:US
Practice Address - Phone:540-216-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty