Provider Demographics
NPI:1811509029
Name:CLARK, BROOKE RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:RENEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:RENEE
Other - Last Name:EMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1117 SE BROWNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3009
Mailing Address - Country:US
Mailing Address - Phone:816-518-3299
Mailing Address - Fax:
Practice Address - Street 1:3600 NE RALPH POWELL RD STE E
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2313
Practice Address - Country:US
Practice Address - Phone:816-228-8393
Practice Address - Fax:816-293-9192
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist