Provider Demographics
NPI:1497217954
Name:VIRELLA, BROOKE (MS)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:
Last Name:VIRELLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 CHENAL PKWY APT 2711
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5202
Mailing Address - Country:US
Mailing Address - Phone:731-501-6531
Mailing Address - Fax:
Practice Address - Street 1:3214 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2929
Practice Address - Country:US
Practice Address - Phone:501-794-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232636721Medicaid