Provider Demographics
NPI:1619750379
Name:STANDRIDGE, BROOKE MARIE (MS, CFY SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:STANDRIDGE
Suffix:
Gender:F
Credentials:MS, CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 MCKENZIE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0870
Mailing Address - Country:US
Mailing Address - Phone:479-750-7778
Mailing Address - Fax:479-750-7708
Practice Address - Street 1:2070 MCKENZIE RD STE C
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0870
Practice Address - Country:US
Practice Address - Phone:479-750-7778
Practice Address - Fax:479-750-7708
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program