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NPI Code Detail

MEDICARE: BROOKE GLENN MS, CCC-SLP

MEDICARE: BROOKE GLENN 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
1235Z00000XSpeech-Language PathologistSLP013862GA

General Provider Information

NPI Number : 1932075066
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE GLENN MS, CCC-SLP
Provider Business Mailing Address
First Line : 1854 AUBURN RD STE 101
Second Line :
City : DACULA
State : GA
Zip : 30019-1130
Country : US
Telephone Number : 770-904-6009
Fax Number : 770-904-2357
Provider Business Practice Location Address
First Line : 1854 AUBURN RD STE 101
Second Line :
City : DACULA
State : GA
Zip : 30019-1130
Country : US
Telephone Number : 770-904-6009
Fax Number : 770-904-2357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2025
Last Update Date : 10/15/2025

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

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