Provider Demographics
NPI:1245570746
Name:BROPHY, CRISTIN ASHLEY (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:ASHLEY
Last Name:BROPHY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E CAPITOL ST SE
Mailing Address - Street 2:APARTMENT #4
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1532
Mailing Address - Country:US
Mailing Address - Phone:313-613-6120
Mailing Address - Fax:
Practice Address - Street 1:1405 E CAPITOL ST SE
Practice Address - Street 2:APARTMENT #4
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1532
Practice Address - Country:US
Practice Address - Phone:313-613-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005958235Z00000X
DCSLP000433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist