Provider Demographics
NPI:1174257471
Name:REA, BROOKLYN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14968 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-6425
Mailing Address - Country:US
Mailing Address - Phone:318-669-1451
Mailing Address - Fax:
Practice Address - Street 1:14968 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-6425
Practice Address - Country:US
Practice Address - Phone:318-669-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist