Provider Demographics
NPI:1437638277
Name:VANCIL, BROOKE (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VANCIL
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:GUNNELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3721 FISCAL CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8167
Mailing Address - Country:US
Mailing Address - Phone:817-691-2464
Mailing Address - Fax:
Practice Address - Street 1:15820 ADDISON RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3549
Practice Address - Country:US
Practice Address - Phone:866-919-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist