Provider Demographics
NPI:1417099516
Name:BROOKS, DONNA SUE (MED, CF, SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SUE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MED, CF, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 RED HAWK LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-5656
Mailing Address - Country:US
Mailing Address - Phone:706-778-7990
Mailing Address - Fax:
Practice Address - Street 1:541 HISTORIC HWY. 441 NORTH
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-0029
Practice Address - Fax:706-754-0088
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist