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General NPI Number Information
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NPI Number | 1508496886
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Entity Type | Individual
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Provider Name | LOIS JEAN BRADY MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 195 GLEN COVE MARINA RD E STE 200
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City | VALLEJO
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State | CA
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Zip | 94591-7291
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Country | US
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Telephone | 707-651-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 649 MAIN ST # 229
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City | MARTINEZ
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State | CA
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Zip | 94553-1137
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Country | US
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Telephone | 925-812-0037
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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 | 7470
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License Number State | CA
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