Provider Demographics
NPI:1700190337
Name:DESHOTELS, BROOKE L
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:DESHOTELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LEMOINE RD
Mailing Address - Street 2:
Mailing Address - City:PLAUCHEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71362-2109
Mailing Address - Country:US
Mailing Address - Phone:318-359-8711
Mailing Address - Fax:
Practice Address - Street 1:151 LEMOINE RD
Practice Address - Street 2:
Practice Address - City:PLAUCHEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71362-2109
Practice Address - Country:US
Practice Address - Phone:318-359-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist