Provider Demographics
NPI:1457775256
Name:BIRCH, BROOKE ALLYCENT
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALLYCENT
Last Name:BIRCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 KINGSRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1159
Mailing Address - Country:US
Mailing Address - Phone:330-932-0111
Mailing Address - Fax:
Practice Address - Street 1:2460 BORING LN
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-4464
Practice Address - Country:US
Practice Address - Phone:330-386-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist