Provider Demographics
NPI:1962783688
Name:BROMER, DENISE M (SLP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:BROMER
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 1:3100 TRADITION CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7200
Mailing Address - Country:US
Mailing Address - Phone:843-654-7945
Mailing Address - Fax:843-884-6481
Practice Address - Street 1:3100 TRADITION CIR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7200
Practice Address - Country:US
Practice Address - Phone:843-654-7945
Practice Address - Fax:843-884-6481
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4296235Z00000X
SC351565294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4296OtherLICENSE #