Healthcare Provider Details

I. General information

NPI: 1497217954
Provider Name (Legal Business Name): BROOKE VIRELLA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/23/2024
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 WINCHESTER DR
BENTON AR
72015-2929
US

IV. Provider business mailing address

13500 CHENAL PKWY APT 2711
LITTLE ROCK AR
72211-5202
US

V. Phone/Fax

Practice location:
  • Phone: 501-794-6482
  • Fax:
Mailing address:
  • Phone: 731-501-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: