Provider Demographics
NPI:1295404929
Name:TAGUE, BROOKE LYNN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:TAGUE
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N CAMBELL ST STE A
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1726
Mailing Address - Country:US
Mailing Address - Phone:605-716-2634
Mailing Address - Fax:
Practice Address - Street 1:110 N CAMBELL ST STE A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1726
Practice Address - Country:US
Practice Address - Phone:605-716-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD975-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist