Provider Demographics
NPI:1407225634
Name:CANNIE, BROOKE BADGETT (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BADGETT
Last Name:CANNIE
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 1:39 LUDLOW STREET APT #4
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:516-263-4924
Mailing Address - Fax:
Practice Address - Street 1:5 FREDERICK DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5932
Practice Address - Country:US
Practice Address - Phone:516-263-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY025987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist