Provider Demographics
NPI:1033227541
Name:BROOKS, SONYA M (MA CCS SLP)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA CCS SLP
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Other - Credentials:
Mailing Address - Street 1:2501 SUTHERLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-3741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1727 IMPERIAL BLVD BLDG 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-478-5880
Practice Address - Fax:337-478-5879
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B103DF17Medicare PIN