Provider Demographics
NPI:1255733903
Name:BROOKS, STACY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-1678
Mailing Address - Country:US
Mailing Address - Phone:918-251-7199
Mailing Address - Fax:539-777-2501
Practice Address - Street 1:2603 S 15TH PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7285
Practice Address - Country:US
Practice Address - Phone:918-251-7199
Practice Address - Fax:539-777-2501
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist