Provider Demographics
NPI:1841329182
Name:BROOKS, ADAM (MS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 PRESNAR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-5139
Mailing Address - Country:US
Mailing Address - Phone:724-866-0271
Mailing Address - Fax:
Practice Address - Street 1:287 PRESNAR DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-5139
Practice Address - Country:US
Practice Address - Phone:724-866-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005670L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000064000006OtherMEDICAL ASSISTANCE