MEDICARE: MRS. JULIE PISCORIK BROTHERS M.S., CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5547	NC

General Provider Information

NPI Number	:	1003855248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE PISCORIK BROTHERS M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	106 KINGSWOOD BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7726
Country	:	US
Telephone Number	:	252-333-1020
Fax Number	:	252-333-1012

Provider Business Practice Location Address
First Line	:	106 KINGSWOOD BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7726
Country	:	US
Telephone Number	:	252-333-1020
Fax Number	:	252-333-1012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	01/27/2010

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