Provider Demographics
NPI:1275772881
Name:GARDNER, BROOKE SELIG (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:SELIG
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELLEN
Other - Last Name:SELIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 251418
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1418
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:1301 WOLFE ST RM 332
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5320
Practice Address - Country:US
Practice Address - Phone:501-526-8008
Practice Address - Fax:501-526-8047
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8135235Z00000X
ARSP2700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174996721Medicaid