Provider Demographics
NPI:1013309012
Name:WILSON, BROOKE (MA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:TALCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 POPE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033-2510
Mailing Address - Country:US
Mailing Address - Phone:978-875-0690
Mailing Address - Fax:
Practice Address - Street 1:22 MILFORD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:NH
Practice Address - Zip Code:03033-2446
Practice Address - Country:US
Practice Address - Phone:603-673-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76780235Z00000X
NH1944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist