Provider Demographics
NPI:1174239818
Name:BRODAHL, APRIL SAMONE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:APRIL
Middle Name:SAMONE
Last Name:BRODAHL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8721 HANNA LN NE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4648
Mailing Address - Country:US
Mailing Address - Phone:360-490-7720
Mailing Address - Fax:
Practice Address - Street 1:12223 A ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5114
Practice Address - Country:US
Practice Address - Phone:253-298-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP613914472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant