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General NPI Number Information
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NPI Number | 1417702259
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Entity Type | Individual
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Provider Name | BROOKE ALEXA FOURCADE
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Gender | Female
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 4404 UNIVERSITY BLVD
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City | DALLAS
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State | TX
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Zip | 75205-1639
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Country | US
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Telephone | 504-994-2532
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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 | 121427
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License Number State | TX
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