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General NPI Number Information
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NPI Number | 1659608347
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Entity Type | Individual
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Provider Name | AMY BRODERICK QBHP
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Gender | Female
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 707 N CARDINAL DR STE 7
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3274
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Country | US
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Telephone | 870-425-5644
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Fax |
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Provider Business Mailing Address
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Address Line | 711 BRADLEY DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2733
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Country | US
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Telephone |
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 27942-M
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License Number State | AR
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