Provider Demographics
NPI:1184066417
Name:ANDERSON, BROOKE KAILEY (SLP)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:KAILEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 CAPITOL BLVD
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1338
Mailing Address - Country:US
Mailing Address - Phone:618-697-2477
Mailing Address - Fax:
Practice Address - Street 1:115 CAPITOL BLVD
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1338
Practice Address - Country:US
Practice Address - Phone:618-697-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002446A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist