Provider Demographics
NPI:1164075644
Name:THALL, BROOKE RAE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RAE
Last Name:THALL
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PAYNE HILL RD APT 140
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-4036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:511 PAYNE HILL RD APT 140
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-4036
Practice Address - Country:US
Practice Address - Phone:717-422-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist