Marcel Leah Broadway, M.S., CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Whitehall, PA
NPI 1205969136 · NPPES record last updated Sep 26, 2013
Key facts
- NPI
- 1205969136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SL003763L (PA)
- Practice address
- 3721 Crescent CT W
Whitehall, PA 18052-3446 - Phone
- (610) 820-7667
- Fax
- (610) 820-7671
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL003763L | PA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cynthia Miles & Associates, LLC | Speech-Language Pathologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL003763L | PA | Yes |
Addresses
Primary practice location
3721 Crescent CT W
Whitehall, PA 18052-3446
Mailing address
3721 Crescent CT W
Whitehall, PA 18052-3446
Phone (610) 820-7667
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019280600002 | Medicaid | PA |
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All providers in Whitehall, PA · Speech-Language Pathologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.