MEDICARE: BROOKE D'ANGELI 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	SL008641	PA
2	235Z00000X	Speech-Language Pathologist	SP-1340	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275659559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE D'ANGELI MS, CCC-SLP

Provider Business Mailing Address
First Line	:	10425 CHIMNEY FLAT CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4527
Country	:	US
Telephone Number	:	484-459-9045
Fax Number	:

Provider Business Practice Location Address
First Line	:	10425 CHIMNEY FLAT CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4527
Country	:	US
Telephone Number	:	484-459-9045
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	03/02/2011

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Directions to “ BROOKE D'ANGELI MS, CCC-SLP” Practice Location

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