Provider Demographics
NPI:1568737591
Name:CLAUSEN, BROOKE (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:BROOKE
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:4161 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3977
Mailing Address - Country:US
Mailing Address - Phone:770-826-4499
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR BLDG 1
Practice Address - Street 2:SUITE 133
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:678-733-9318
Practice Address - Fax:404-902-5440
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist