Provider Demographics
NPI:1629293840
Name:DORSCH, BROOKE THOMAS (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:THOMAS
Last Name:DORSCH
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ANTONIA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:300 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-9759
Mailing Address - Country:US
Mailing Address - Phone:724-422-0278
Mailing Address - Fax:
Practice Address - Street 1:3023 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1242
Practice Address - Country:US
Practice Address - Phone:724-656-8814
Practice Address - Fax:724-656-8815
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011098780001OtherMEDICAL ASSISTANCE NUMBER