Provider Demographics
NPI:1316668619
Name:BORDEAUX, BRITTANY LYNETTE (SLPA)
Entity type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:LYNETTE
Last Name:BORDEAUX
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 RUSSELL DR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4549
Mailing Address - Country:US
Mailing Address - Phone:727-687-6786
Mailing Address - Fax:
Practice Address - Street 1:501 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6939
Practice Address - Country:US
Practice Address - Phone:727-452-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL54282355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant