MEDICARE: BRIANNA WALSH M.A. 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	SP-1999	NV
2	235Z00000X	Speech-Language Pathologist	026941	NY
3	235Z00000X	Speech-Language Pathologist	SLP.0003225	CO

General Provider Information

NPI Number	:	1104375997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA WALSH M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	5 W GATE DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-6021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 TELSTAR DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1028
Country	:	US
Telephone Number	:	719-305-8900
Fax Number	:

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

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	11/13/2023

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