Provider Demographics
NPI:1932336484
Name:AMBROSE, BROOKE M (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2104
Mailing Address - Country:US
Mailing Address - Phone:716-410-2337
Mailing Address - Fax:
Practice Address - Street 1:620 MAURADER DRIVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-1002
Practice Address - Country:US
Practice Address - Phone:716-366-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018921-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist