Provider Demographics
NPI:1992278659
Name:PRESTON, BRONWYN ROBERTS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRONWYN
Middle Name:ROBERTS
Last Name:PRESTON
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 1:12496 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44046-9792
Mailing Address - Country:US
Mailing Address - Phone:440-635-5567
Mailing Address - Fax:
Practice Address - Street 1:12496 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:HUNTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44046-9792
Practice Address - Country:US
Practice Address - Phone:440-635-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist