MEDICARE: BROOKE CROSS

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	SLP010390	GA

General Provider Information

NPI Number	:	1457166266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE CROSS

Provider Business Mailing Address
First Line	:	2 GILMORE RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-4442
Country	:	US
Telephone Number	:	334-664-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 GILMORE RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-4442
Country	:	US
Telephone Number	:	334-664-0463
Fax Number	:

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

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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Directions to “ BROOKE CROSS ” Practice Location

Language	Start Address	Practice Location

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