Provider Demographics
NPI:1477188258
Name:SANDERLIN, BROOKE FUTCH
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:FUTCH
Last Name:SANDERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CARRIAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3802
Mailing Address - Country:US
Mailing Address - Phone:318-372-4015
Mailing Address - Fax:
Practice Address - Street 1:3326 FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6418
Practice Address - Country:US
Practice Address - Phone:318-435-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist