Provider Demographics
NPI:1346315793
Name:BROOKS, CARLA ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 212TH ST SW
Mailing Address - Street 2:STE 105
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7525
Mailing Address - Country:US
Mailing Address - Phone:425-501-4856
Mailing Address - Fax:
Practice Address - Street 1:7907 212TH ST SW
Practice Address - Street 2:STE 105
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7525
Practice Address - Country:US
Practice Address - Phone:425-501-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602-381-307OtherUBI
WA7028319Medicaid
WA4761BROtherREGENCE BLUESHIELD NUMBER
WA83-0390536OtherTAX ID #
WA01023847OtherASHA
WA261943001OtherSTATE TAX ID
WA46301Medicaid
WA7015157OtherAETNA INSURANCE NUMBER
WA8383796Medicaid