Healthcare Provider Details

I. General information

NPI: 1093167033
Provider Name (Legal Business Name): BRITTANIE A. TILLMAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 BUSTLETON AVE STE 1A
PHILADELPHIA PA
19116-1188
US

IV. Provider business mailing address

6901 N CHARLES ST
TOWSON MD
21204-3780
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-6523
  • Fax: 215-613-6527
Mailing address:
  • Phone: 443-809-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL012659
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10035
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: