Provider Demographics
NPI:1700900271
Name:SHIVE, BROOKE NICOLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:NICOLE
Last Name:SHIVE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WATERLILY RD
Mailing Address - Street 2:
Mailing Address - City:COINJOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27923-9746
Mailing Address - Country:US
Mailing Address - Phone:704-798-1423
Mailing Address - Fax:
Practice Address - Street 1:1103 WATERLILY RD
Practice Address - Street 2:
Practice Address - City:COINJOCK
Practice Address - State:NC
Practice Address - Zip Code:27923-9746
Practice Address - Country:US
Practice Address - Phone:704-798-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist