DEBRA LYNN BRODERICK (NPI# 1134613243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134613243 |
| Entity Type | Individual |
| Full Name | DEBRA LYNN BRODERICK |
| Credential | CDCA |
| Practice Address |
30663 Red Rock Ct # 1 Logan OH 43138-9672 |
| Practice Telephone | 7408881377 |
| Practice Fax Number | 7408792970 |
| Mailing Telephone | 7408881377 |
| Mailing Fax Number | 7408792970 |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-06-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
164844 | OH | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0096642 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417371840 | Debra Lynn Broderick | Physical Therapy Assistant | 300 Sunset Cir, Moultrie, GA 31768-6934 | 2014-02-05 |
| 1639204423 | Debra Jean Broderick | Psychologist | 357 Kellogg Blvd E, Saint Paul, MN 55101-1411 | 2007-02-22 |
| Street Address |
30663 RED ROCK CT # 1 |
| City | LOGAN |
| State | OH |
| Zip Code | 43138-9672 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053876623 | Brock Wolford | Counselor | 30663 Red Rock Ct # 1, Logan, OH 43138-9672 | 2019-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538667696 | Kelsey Whalen | Social Worker | 541 Sr 93 N, Suite C, Logan, OH 43138 | 2018-01-24 |
| 1144728205 | Raeann Harry-boothe | Counselor | 313 Chieftain Dr, Logan, OH 43138 | 2018-01-24 |
| 1336661784 | Megan Correll | Nurse Practitioner | 541 Sr 664n, Suite C, Logan, OH 43138 | 2017-07-07 |
| 1841735800 | Coler Drug Logan, Ltd | Durable Medical Equipment & Medical Supplies | 21 Hocking Mall, Logan, OH 43138 | 2016-12-30 |
| 1932515418 | Melissa O'harra-brown | Nurse Practitioner | 541 Sr 664 N, Suite C, Logan, OH 43138 | 2014-07-07 |
| 1790198950 | Matthew R Williams | Audiologist | 1323 West Hunter St., Logan, OH 43138 | 2014-06-05 |
| 1194138651 | Diles Logan Hearing Center, L.L.C. | Audiologist | 1323 West Hunter Street, Logan, OH 43138 | 2014-06-03 |
| 1205252210 | Shaun Crisp | Occupational Therapy Assistant | 601 Ohio 664, Hocking Valley Community Hospital, Logan, OH 43138 | 2014-03-14 |
| 1467780056 | Natalie Simpson | Licensed Practical Nurse | 583 E Second St, Logan, OH 43138 | 2009-11-20 |
| 1821243262 | Angela Rose Hartbarger | Counselor | 541 St. Rt. 664, Suite C, Logan, OH 43138 | 2008-11-26 |
| Find all providers in zip 43138 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124590518 | Hannah Beth James | Counselor | 107 N 4th Ave Ste 8, Logan, IA 51546 | 2018-12-22 |
| 1073010815 | Rebecca Faith Rich-fidler | Counselor | 30811 Lake Logan Rd, Logan, OH 43138-9546 | 2018-04-09 |
| 1134620925 | Kay S Ansel | Counselor | 141 S Spring St, Logan, OH 43138-1859 | 2018-02-27 |
| 1578075214 | Michele Saegert | Counselor | 12877 Grey St, Logan, OH 43138-9638 | 2017-11-03 |
| 1497294052 | Guy Taylor | Counselor | 1222 W Hunter St, Logan, OH 43138-1012 | 2017-02-15 |
| 1861930836 | Joseph Michael Mounts | Counselor | 312 Hudgins St, Logan, WV 25601 | 2017-02-09 |
| 1528418241 | Cheryl Spence | Counselor | 12896 Grey St, Logan, OH 43138-9638 | 2016-06-14 |
| 1578993457 | Brett Knott Jr. | Counselor | 12888 Grey St, Logan, OH 43138-9638 | 2013-11-14 |
| 1053876623 | Brock Wolford | Counselor | 30663 Red Rock Ct # 1, Logan, OH 43138-9672 | 2019-02-07 |
| 1346705498 | Beth Brooks | Counselor | 12877 Grey St, Logan, OH 43138-9638 | 2019-02-04 |
| Find all providers in LOGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.