Provider Demographics
NPI:1265701221
Name:WARREN, BROOKE ELIZABETH (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1430
Mailing Address - Country:US
Mailing Address - Phone:585-507-7778
Mailing Address - Fax:
Practice Address - Street 1:953 HIGH ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1168
Practice Address - Country:US
Practice Address - Phone:585-924-3252
Practice Address - Fax:585-742-7031
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0206071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist