Provider Demographics
NPI:1093409088
Name:BROOKS, HAVEN CRAWLEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:CRAWLEY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:HAVEN
Other - Middle Name:BROOKE
Other - Last Name:CRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 LOUIS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5195
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:
Practice Address - Street 1:301 LOUIS ST STE 101
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5195
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011305235Z00000X
TN8286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist