Provider Demographics
NPI:1669665071
Name:FITZGERALD, BRIANNE KATHLEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:KATHLEEN
Last Name:FITZGERALD
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:20408 ROCKAWAY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1115
Mailing Address - Country:US
Mailing Address - Phone:718-551-4678
Mailing Address - Fax:347-230-4074
Practice Address - Street 1:20408 ROCKAWAY POINT BLVD
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1115
Practice Address - Country:US
Practice Address - Phone:718-551-4678
Practice Address - Fax:347-230-4074
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016161-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist