Provider Demographics
NPI:1669924502
Name:PICCOLOTTI, BRIGID MARIE-CROTTY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIGID
Middle Name:MARIE-CROTTY
Last Name:PICCOLOTTI
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BRIGID
Other - Middle Name:MARIE
Other - Last Name:CROTTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:7005 NE OREGON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5576
Mailing Address - Country:US
Mailing Address - Phone:503-660-3231
Mailing Address - Fax:
Practice Address - Street 1:16703 SE MCGILLIVRAY BLVD STE 170
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4301
Practice Address - Country:US
Practice Address - Phone:360-989-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61470312235Z00000X
OR015923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR015923OtherBOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY
WALL61470312OtherWASHINGTON STATE DEPARTMENT OF HEALTH BOARD OF HEARING AND SPEECH