Provider Demographics
NPI:1386936490
Name:BROADWAY, KIRK LOYD
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:LOYD
Last Name:BROADWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 AUBURN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4139
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:
Practice Address - Street 1:4441 AUBURN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4139
Practice Address - Country:US
Practice Address - Phone:916-473-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst