Provider Demographics
NPI:1801932876
Name:BERRYMAN, BROOKE JOUROLMON (SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JOUROLMON
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GLENCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-5371
Mailing Address - Country:US
Mailing Address - Phone:229-938-4746
Mailing Address - Fax:229-273-9884
Practice Address - Street 1:9 GLENCASTLE CT
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-5371
Practice Address - Country:US
Practice Address - Phone:229-938-4746
Practice Address - Fax:229-273-9884
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0004712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist