Provider Demographics
NPI:1609171503
Name:HART, BROOKE (A-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:A-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ROWLETT RD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3700
Mailing Address - Country:US
Mailing Address - Phone:972-303-7021
Mailing Address - Fax:972-303-7020
Practice Address - Street 1:545 ROWLETT RD
Practice Address - Street 2:SUITE A & B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3700
Practice Address - Country:US
Practice Address - Phone:972-303-7021
Practice Address - Fax:972-303-7020
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359452355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicare PIN
TX456606Medicare PIN
TX676535Medicare PIN