Provider Demographics
NPI:1700030293
Name:HAAS, BROOKE M (MS SLP CCC)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:M
Last Name:HAAS
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E 76TH ST
Mailing Address - Street 2:A 1507
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2547
Mailing Address - Country:US
Mailing Address - Phone:516-567-2053
Mailing Address - Fax:
Practice Address - Street 1:370 E 76TH ST
Practice Address - Street 2:A 1507
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2547
Practice Address - Country:US
Practice Address - Phone:516-567-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017116-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist