Provider Demographics
NPI:1881176394
Name:BROOKS, ANGELA RAYNELL (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAYNELL
Last Name:BROOKS
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 1:2323 E MOSSY OAKS RD APT 250
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1608
Mailing Address - Country:US
Mailing Address - Phone:479-461-2339
Mailing Address - Fax:
Practice Address - Street 1:1014 WINDSOR LAKES BLVD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4886
Practice Address - Country:US
Practice Address - Phone:479-461-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0
235Z00000XOtherSPEECH THERAPIST