Provider Demographics
NPI:1619286358
Name:RADABAUGH, BROOKE ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLEY
Last Name:RADABAUGH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3924
Mailing Address - Country:US
Mailing Address - Phone:512-918-0044
Mailing Address - Fax:512-918-0045
Practice Address - Street 1:1103 CYPRESS CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3924
Practice Address - Country:US
Practice Address - Phone:512-918-0044
Practice Address - Fax:512-918-0045
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist