Provider Demographics
NPI:1689792418
Name:TOWNSEND, BROOKE VITA (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:VITA
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:VITA
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:744 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5901
Mailing Address - Country:US
Mailing Address - Phone:239-542-6732
Mailing Address - Fax:
Practice Address - Street 1:9732 COMMERCE CENTER CT
Practice Address - Street 2:UNIT A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3647
Practice Address - Country:US
Practice Address - Phone:239-332-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9121OtherBCBS
FLS9121OtherBCBS