Healthcare Provider Details

I. General information

NPI: 1104375997
Provider Name (Legal Business Name): BRIANNA WALSH M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 NORTHERN BLVD
GREENVALE NY
11548-1319
US

IV. Provider business mailing address

5 W GATE DR
HUNTINGTON NY
11743-6021
US

V. Phone/Fax

Practice location:
  • Phone: 516-299-4108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24834
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026941
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0003225
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1999
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: