Healthcare Provider Details

I. General information

NPI: 1467478149
Provider Name (Legal Business Name): MEGHAN KELLY BROZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CLARK MILL ST
COVENTRY RI
02816-6338
US

IV. Provider business mailing address

31 CLARK MILL ST
COVENTRY RI
02816-6338
US

V. Phone/Fax

Practice location:
  • Phone: 401-595-2950
  • Fax:
Mailing address:
  • Phone: 401-595-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP00143-P
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: