Provider Demographics
NPI:1255665568
Name:HARRIS, BROOKE SUZANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:SUZANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:SUZANNE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:6 FISHER HILL DR.
Mailing Address - Street 2:
Mailing Address - City:BIGELOW
Mailing Address - State:AR
Mailing Address - Zip Code:72016
Mailing Address - Country:US
Mailing Address - Phone:501-889-8459
Mailing Address - Fax:
Practice Address - Street 1:1301 RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-967-2322
Practice Address - Fax:479-967-2876
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8251235Z00000X
ARSP#2843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist