Provider Demographics
NPI:1427534452
Name:BUCHANAN, BROOKE CECILE (MED, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:CECILE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MED, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 E 7250 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4107
Mailing Address - Country:US
Mailing Address - Phone:435-770-6510
Mailing Address - Fax:
Practice Address - Street 1:471 HERITAGE PARK BLVD # 52444N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5712
Practice Address - Country:US
Practice Address - Phone:801-217-3390
Practice Address - Fax:844-854-4658
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7829925-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist