Provider Demographics
NPI:1760518542
Name:BROSH, LEE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:BROSH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHATEL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9113
Mailing Address - Country:US
Mailing Address - Phone:501-993-7171
Mailing Address - Fax:501-223-8075
Practice Address - Street 1:17200 CHENAL PKWY
Practice Address - Street 2:SUITE 300, #107
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5944
Practice Address - Country:US
Practice Address - Phone:501-993-7171
Practice Address - Fax:501-223-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist