Provider Demographics
NPI:1699921528
Name:BRZOSKA, GLENDA LYNN
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:LYNN
Last Name:BRZOSKA
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 1:2584 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5738
Mailing Address - Country:US
Mailing Address - Phone:716-627-6756
Mailing Address - Fax:
Practice Address - Street 1:2584 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5738
Practice Address - Country:US
Practice Address - Phone:716-627-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008117-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist