Provider Demographics
NPI:1225206386
Name:BROKAS, STEFANIE ALEXIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:ALEXIS
Last Name:BROKAS
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 1:502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5014
Mailing Address - Country:US
Mailing Address - Phone:863-877-0688
Mailing Address - Fax:863-209-7018
Practice Address - Street 1:502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5014
Practice Address - Country:US
Practice Address - Phone:863-877-0688
Practice Address - Fax:863-209-7018
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888977500Medicaid