Provider Demographics
NPI:1861613937
Name:BROEG, CHARLOTTE MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:BROEG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:MARIE
Other - Last Name:SINGLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:61 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2302
Mailing Address - Country:US
Mailing Address - Phone:859-801-1448
Mailing Address - Fax:859-435-7088
Practice Address - Street 1:61 BEECH DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2302
Practice Address - Country:US
Practice Address - Phone:859-331-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist