Provider Demographics
NPI:1376709659
Name:BROOKS, SUSAN D (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
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 1:193 W BARE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1627
Mailing Address - Country:US
Mailing Address - Phone:978-456-3130
Mailing Address - Fax:
Practice Address - Street 1:193 WEST BARE HILL RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1627
Practice Address - Country:US
Practice Address - Phone:978-456-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist