Healthcare Provider Details

I. General information

NPI: 1588570964
Provider Name (Legal Business Name): BROOKE FALWELL M.S. CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 MOUNT SHASTA DR
SAN PEDRO CA
90732-1327
US

IV. Provider business mailing address

2156 MOUNT SHASTA DR
SAN PEDRO CA
90732-1327
US

V. Phone/Fax

Practice location:
  • Phone: 310-710-1845
  • Fax:
Mailing address:
  • Phone: 310-710-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: