MEDICARE: BRIE ANN BOLANDER M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4147-154	WI
2	235Z00000X	Speech-Language Pathologist	30003569	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	52-6552	OTHER	WI	MEDICARE#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124572458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIE ANN BOLANDER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	440 CENTRAL AVE
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-2634
Country	:	US
Telephone Number	:	336-236-6546
Fax Number	:	336-236-9546

Provider Business Practice Location Address
First Line	:	440 CENTRAL AVE
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-2634
Country	:	US
Telephone Number	:	336-236-6546
Fax Number	:	336-236-9546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	01/06/2026

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Directions to “ BRIE ANN BOLANDER M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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