Provider Demographics
NPI:1376851055
Name:SIMER, BROOKE V (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:V
Last Name:SIMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:HEATHER
Other - Last Name:VRCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1628 BYRON NELSON PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9633
Mailing Address - Country:US
Mailing Address - Phone:817-488-4128
Mailing Address - Fax:
Practice Address - Street 1:1628 BYRON NELSON PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9633
Practice Address - Country:US
Practice Address - Phone:817-488-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist