MEDICARE: JAMIE M BROD

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	COND.20222241-SLP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	983087717	OTHER	OH	BLUE SKY THERAPY

General Provider Information

NPI Number	:	1801502042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE M BROD

Provider Business Mailing Address
First Line	:	3916 PERKINS AVE
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1059
Country	:	US
Telephone Number	:	419-627-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	3916 PERKINS AVE
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1059
Country	:	US
Telephone Number	:	419-627-8733
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “ JAMIE M BROD ” Practice Location

Language	Start Address	Practice Location

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