Provider Demographics
NPI:1417914482
Name:BROOKS, SYDNEY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TAPP RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6844
Mailing Address - Country:US
Mailing Address - Phone:321-501-0282
Mailing Address - Fax:
Practice Address - Street 1:1117 TAPP RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6844
Practice Address - Country:US
Practice Address - Phone:321-501-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4119235Z00000X
ARSP#487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116145721Medicaid
FL891401000Medicaid