Provider Demographics
NPI:1912153677
Name:NORMAND, BROOKE FONTENOT (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:FONTENOT
Last Name:NORMAND
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-0003
Mailing Address - Country:US
Mailing Address - Phone:318-346-6225
Mailing Address - Fax:
Practice Address - Street 1:6661 HIGHWAY 115
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-4245
Practice Address - Country:US
Practice Address - Phone:318-346-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist