Healthcare Provider Details

I. General information

NPI: 1275044620
Provider Name (Legal Business Name): PATRICIA LEE ALLEN BRICKMAN MS,CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 NW 2ND AVE STE 104
BOCA RATON FL
33431-6692
US

IV. Provider business mailing address

W379N5782 N LAKE RD
OCONOMOWOC WI
53066-2265
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-5976
  • Fax: 888-238-3365
Mailing address:
  • Phone: 262-444-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number666-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: