Provider Demographics
NPI:1386238236
Name:MAGILL, BROGAN (SLP)
Entity type:Individual
Prefix:
First Name:BROGAN
Middle Name:
Last Name:MAGILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20071 SULMONA DR
Mailing Address - Street 2:
Mailing Address - City:FRIANT
Mailing Address - State:CA
Mailing Address - Zip Code:93626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 E BULLARD AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5455
Practice Address - Country:US
Practice Address - Phone:559-205-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist