Provider Demographics
NPI:1376166058
Name:SHEENA, BROOKE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SHEENA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFLD HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2140
Mailing Address - Country:US
Mailing Address - Phone:248-497-2205
Mailing Address - Fax:
Practice Address - Street 1:631 E BIG BEAVER RD STE 107
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1400
Practice Address - Country:US
Practice Address - Phone:248-497-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7101006791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist