Provider Demographics
NPI:1144471228
Name:BRODSKY, MARTIN B (PHD, SCM)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:B
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:PHD, SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # A71
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-6468
Mailing Address - Fax:216-445-9409
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0005
Practice Address - Country:US
Practice Address - Phone:216-445-6468
Practice Address - Fax:216-445-9409
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15111235Z00000X
MD05850235Z00000X
SC3520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist