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General NPI Number Information
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NPI Number | 1255665568
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Entity Type | Individual
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Provider Name | BROOKE SUZANNE HARRIS MS. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 1301 RUSSELL ROAD
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City | RUSSELLVILLE
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State | AR
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Zip | 72801
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Country | US
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Telephone | 479-967-2322
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Fax | 479-967-2876
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Provider Business Mailing Address
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Address Line | 6 FISHER HILL DR.
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City | BIGELOW
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State | AR
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Zip | 72016
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Country | US
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Telephone | 501-889-8459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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#P8251
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP#2843
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License Number State | AR
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