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NPI Code Detail

MEDICARE: BROOKE LONG M.S., CCC-SLP

MEDICARE:   BROOKE  LONG  M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist102838TX

General Provider Information

NPI Number : 1417618810
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE LONG M.S., CCC-SLP
Provider Business Mailing Address
First Line : 5730 WILFORD DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75070-9025
Country : US
Telephone Number : 214-663-0182
Fax Number :
Provider Business Practice Location Address
First Line : 5730 WILFORD DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75070-9025
Country : US
Telephone Number : 214-663-0182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2022
Last Update Date : 01/07/2022

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Directions to “ BROOKE LONG M.S., CCC-SLP” Practice Location

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