Provider Demographics
NPI:1285931048
Name:BROYLES, RANDI M
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:M
Last Name:BROYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35105 KENAI SPUR HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7621
Mailing Address - Country:US
Mailing Address - Phone:907-260-7400
Mailing Address - Fax:907-260-7444
Practice Address - Street 1:35105 KENAI SPUR HWY
Practice Address - Street 2:SUITE A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7621
Practice Address - Country:US
Practice Address - Phone:907-260-7400
Practice Address - Fax:907-260-7444
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant