MEDICARE: BRITTANY ELDRIDGE

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	120764	TX

General Provider Information

NPI Number	:	1417641341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY ELDRIDGE

Provider Business Mailing Address
First Line	:	3212 SAGESTONE DR APT 4314
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 SAGESTONE DR APT 4314
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1904
Country	:	US
Telephone Number	:	281-702-4133
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “ BRITTANY ELDRIDGE ” Practice Location

Language	Start Address	Practice Location

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