Provider Demographics
NPI:1285208942
Name:OWEN, BROOKE ALLISON (SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALLISON
Last Name:OWEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ALLISON
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1911 W C ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2367
Mailing Address - Country:US
Mailing Address - Phone:918-409-0157
Mailing Address - Fax:918-209-4788
Practice Address - Street 1:1911 W C ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2367
Practice Address - Country:US
Practice Address - Phone:918-409-0157
Practice Address - Fax:918-209-4788
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist