Provider Demographics
NPI:1437634912
Name:ALEXANDER, BROOKE JOHNSON (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:JOHNSON
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8660 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5655
Mailing Address - Country:US
Mailing Address - Phone:925-626-7474
Mailing Address - Fax:
Practice Address - Street 1:8660 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5655
Practice Address - Country:US
Practice Address - Phone:925-626-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6698390200000X
CA31961246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program