Provider Demographics
NPI:1275854325
Name:LAMBERT, BROOKE MARTIN (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARTIN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 HUNTER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-6052
Mailing Address - Country:US
Mailing Address - Phone:757-650-3350
Mailing Address - Fax:
Practice Address - Street 1:6506 LOISDALE RD STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1815
Practice Address - Country:US
Practice Address - Phone:703-924-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist