Provider Demographics
NPI:1679734024
Name:BARNES, BROOKE LARAYNE (SPEECH THERAPIST (MS)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LARAYNE
Last Name:BARNES
Suffix:
Gender:F
Credentials:SPEECH THERAPIST (MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 F GLENDA TRACE
Mailing Address - Street 2:STE #414
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-502-9740
Mailing Address - Fax:770-683-4250
Practice Address - Street 1:39 ROLLINGBROOK VISTA
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-502-9740
Practice Address - Fax:770-683-4250
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842455980BMedicaid