Provider Demographics
NPI:1396070090
Name:BROVINA-GALLEGOS, MARIYA N (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:N
Last Name:BROVINA-GALLEGOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARIYA
Other - Middle Name:N
Other - Last Name:BROVINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14881 E MAPLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4709
Mailing Address - Country:US
Mailing Address - Phone:603-204-7948
Mailing Address - Fax:
Practice Address - Street 1:14881 E MAPLEWOOD PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-4709
Practice Address - Country:US
Practice Address - Phone:603-204-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0432235Z00000X
CO0000459235Z00000X
CO217050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist