Provider Demographics
NPI:1124782354
Name:LIPKE, BRIANNE COLLEEN (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:COLLEEN
Last Name:LIPKE
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E GRANDVIEW BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2666
Mailing Address - Country:US
Mailing Address - Phone:814-758-7312
Mailing Address - Fax:
Practice Address - Street 1:15201 NEABSCO MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4005
Practice Address - Country:US
Practice Address - Phone:703-583-1405
Practice Address - Fax:703-580-7280
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty