Individual
JUSTIN BRODT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
601 S 8TH ST, TACOMA, WA 98405-4614
(253) 571-1000
Mailing address
3321 N HUSON ST, TACOMA, WA 98407-4023
(253) 571-5468
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14287090
—
WA
Enumeration date
11/10/2021
Last updated
11/10/2021
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