Provider Demographics
NPI:1457898355
Name:BRODDIE, BRIEENNA
Entity type:Individual
Prefix:
First Name:BRIEENNA
Middle Name:
Last Name:BRODDIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SW HUNZIKER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4956 DEMING RD
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:WA
Practice Address - Zip Code:98244-9242
Practice Address - Country:US
Practice Address - Phone:360-383-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61666326235Z00000X
OR0A05872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant