Provider Demographics
NPI:1790075356
Name:MINTO-BROOKS, EDA-MAE (SLP)
Entity Type:Individual
Prefix:
First Name:EDA-MAE
Middle Name:
Last Name:MINTO-BROOKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:EDA-MAE
Other - Middle Name:
Other - Last Name:MINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4422
Mailing Address - Country:US
Mailing Address - Phone:516-333-7009
Mailing Address - Fax:
Practice Address - Street 1:513 LOWELL ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4422
Practice Address - Country:US
Practice Address - Phone:516-333-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 020026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist