Provider Demographics
NPI:1477112183
Name:WHITNEY, BROOKE A (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:A
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:A
Other - Last Name:SANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:418 S ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2218
Mailing Address - Country:US
Mailing Address - Phone:631-942-7745
Mailing Address - Fax:
Practice Address - Street 1:2815 SAINT LO DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1325
Practice Address - Country:US
Practice Address - Phone:631-942-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist