Provider Demographics
NPI:1467897223
Name:BROCKMEYER, CAROL (MS CCC SLP MBA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:BROCKMEYER
Suffix:
Gender:F
Credentials:MS CCC SLP MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SANDY HOOK RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1909
Mailing Address - Country:US
Mailing Address - Phone:410-937-8841
Mailing Address - Fax:
Practice Address - Street 1:2801 SANDY HOOK RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1909
Practice Address - Country:US
Practice Address - Phone:410-937-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist