Staci Huska Broderick, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8342 Issued in NC

Practice address

7022 Sardis Rd
Charlotte, NC 28270-6058

Phone

(704) 292-4712

NPI assigned

Aug 16, 2006

Last updated

Dec 13, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Staci Huska Broderick Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Lisa E. Cyzner, PHD, Otrl

  • Pediatric Occupational Therapist
  • Charlotte, NC
  • NPI 1629145917
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292198400000",
    "number": "1437262409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7022 SARDIS RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282706058",
            "telephone_number": "704-292-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7022 SARDIS RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282706058",
            "telephone_number": "704-292-4712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "STACI",
        "middle_name": "HUSKA",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2010-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "8342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7413101",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "BRODERICK",
            "middle_name": "HUSKA",
            "prefix": "MRS.",
            "credential": "M.S., CCC-SLP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jack Gilbert Brock Jr., M.D.
• Krystal Dawn Brock, LMFTA
• Jeffrey Clarke Brockman, LPCA
• Kathryn Elizabeth Brockway, PA-C
• Raven Broden
• Shawnte N Brodie
• Megan Colleen Brogan, FNP
• Leigh Brogdon, PT
• Bethany Broj, PSY.D.
• Megan Marie Broman, PA

• Speech-Language Pathologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.