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General NPI Number Information
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NPI Number | 1679741664
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Entity Type | Individual
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Provider Name | ANDREA D BROGAN SLP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | GRANT COUNTY BOARD OF EDUCATION 204 JEFFERSON AVENUE
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City | PETERSBURG
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State | WV
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Zip | 26847
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Country | US
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Telephone | 304-257-1011
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Fax |
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Provider Business Mailing Address
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Address Line | GRANT COUNTY BOARD OF EDUCATION 204 JEFFERSON AVENUE
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City | PETERSBURG
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State | WV
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Zip | 26847
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Country | US
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Telephone | 304-257-1011
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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 | 0823
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License Number State | WV
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