Healthcare Provider Details

I. General information

NPI: 1447607544
Provider Name (Legal Business Name): BROOKE STOYAK SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E NORTH BROADWAY ST
COLUMBUS OH
43214-4114
US

IV. Provider business mailing address

510 E NORTH BROADWAY ST
COLUMBUS OH
43214-4114
US

V. Phone/Fax

Practice location:
  • Phone: 614-263-5151
  • Fax: 614-263-5365
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL260098108234
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.14314
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: