Healthcare Provider Details

I. General information

NPI: 1023353539
Provider Name (Legal Business Name): STEPHANIE BROOKE BROMILEY SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE BROOKE ROBERTSON

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

IV. Provider business mailing address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-7500
  • Fax:
Mailing address:
  • Phone: 360-750-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSP60249309
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: