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General NPI Number Information
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NPI Number | 1285754051
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Entity Type | Individual
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Provider Name | LISA ANN BRODJIESKI M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 9145 GUILFORD RD SUITE 100
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City | COLUMBIA
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State | MD
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Zip | 21046-1883
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Country | US
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Telephone | 410-880-4215
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Fax |
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Provider Business Mailing Address
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Address Line | 301 EDGEMERE DR
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City | ANNAPOLIS
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State | MD
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Zip | 21403-3914
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Country | US
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Telephone | 410-877-4634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 06107
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License Number State | MD
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