Provider Demographics
NPI:1205623311
Name:WALKER, BROOKE (SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WALKER
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 N SHANNON AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-8207
Mailing Address - Country:US
Mailing Address - Phone:386-965-1378
Mailing Address - Fax:
Practice Address - Street 1:2143 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9437
Practice Address - Country:US
Practice Address - Phone:352-781-1356
Practice Address - Fax:352-352-9370
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist