Provider Demographics
NPI:1497253215
Name:SPEARS, BROOKE MARIA (MCD, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:MARIA
Last Name:SPEARS
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S STATE HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:MO
Mailing Address - Zip Code:63933-1367
Mailing Address - Country:US
Mailing Address - Phone:573-246-3109
Mailing Address - Fax:
Practice Address - Street 1:801 S STATE HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:MO
Practice Address - Zip Code:63933-1367
Practice Address - Country:US
Practice Address - Phone:573-246-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist