MEDICARE: BROOKE HAMMOND PECCIA MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 0000002635	TN

General Provider Information

NPI Number	:	1235308156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE HAMMOND PECCIA MS, CCC-SLP

Provider Business Mailing Address
First Line	:	208 SUNSET DR
Second Line	:	SUITE 367
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2517
Country	:	US
Telephone Number	:	423-282-1700
Fax Number	:	423-282-9319

Provider Business Practice Location Address
First Line	:	208 SUNSET DR
Second Line	:	SUITE 367
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2517
Country	:	US
Telephone Number	:	423-282-1700
Fax Number	:	423-282-9319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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Directions to “ BROOKE HAMMOND PECCIA MS, CCC-SLP” Practice Location

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