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General NPI Number Information
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NPI Number | 1700428109
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Entity Type | Individual
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Provider Name | BRITTANY BRILEY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 1527 URBANA RD
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City | SUMMERTON
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State | SC
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Zip | 29148-8929
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Country | US
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Telephone | 803-460-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 1188 CANTERBERRY DR
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City | MANNING
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State | SC
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Zip | 29102-8808
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Country | US
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Telephone | 803-460-6222
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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 | 4955
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License Number State | SC
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