Individual provider Active NPI

Brie Ann Bolander, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Lexington, NC
National Provider Identifier
1124572458
Registry record updated Jan 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
30003569 Issued in NC
Practice address
440 Central Ave
Lexington, NC 27292-2634
Phone
(336) 236-6546
Fax
(336) 236-9546
NPI assigned
Aug 3, 2016
Last updated
Jan 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 4147-154 WI
Speech-Language Pathologist 235Z00000X 30003569 NC Primary

Addresses

Primary practice location

440 Central Ave
Lexington, NC 27292-2634

Mailing address

440 Central Ave
Lexington, NC 27292-2634
Phone (336) 236-6546

Other identifiers 2

IdentifierTypeStateIssuer
1548242829MedicaidWI
52-6552OtherWIMEDICARE#

Other names 1

  • Brie Bowie Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190712002476 WI Practitioner - Qualified Speech Language Pathologist 5890020895 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
30003569NCMDSpeech-Language Pathologist
4147-154WIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Medical Group Inc. CurrentSince Jun 21, 2019 Accepting new patients
Ot4 Kids, Inc Speech-Language Pathologist PastSince May 18, 2025 Accepting new patients
Ot4Kids, Inc. PastSince May 18, 2025 Accepting new patients

Locations

17280 W North Ave
Ste 104
Brookfield, WI 53045
Phone (262) 780-0707

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767657600000",
    "number": "1124572458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 CENTRAL AVE",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272922634",
            "telephone_number": "336-236-6546",
            "fax_number": "336-236-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 CENTRAL AVE",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272922634",
            "telephone_number": "336-236-6546",
            "fax_number": "336-236-9546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANDER",
        "first_name": "BRIE",
        "middle_name": "ANN",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "4147-154",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "30003569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548242829",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE#",
            "identifier": "52-6552",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIE",
            "last_name": "BOWIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lexington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.