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General NPI Number Information
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NPI Number | 1144656042
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Entity Type | Organization
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Legal Business Name | BROOKS SPEECH LANGUAGE THERAPY SERVICES
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 1117 TAPP RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6844
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Country | US
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Telephone | 321-501-0282
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 TAPP RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6844
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Country | US
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Telephone | 321-501-0282
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Fax |
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | SYDNEY BROOKS MASON
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Credential | CCC-SLP
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Telephone | 321-501-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 487
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License Number State | AR
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