Provider Demographics
NPI:1275033813
Name:PINKHAM, BROOKLYNN KAY
Entity Type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:KAY
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NORTHWEST HWY APT 1108
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3682
Mailing Address - Country:US
Mailing Address - Phone:903-280-8383
Mailing Address - Fax:
Practice Address - Street 1:2400 WESTPORT PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-5316
Practice Address - Country:US
Practice Address - Phone:817-773-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant