Provider Demographics
NPI:1952011785
Name:WALPOLE, BROOKE
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:WALPOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N QUENTIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4623
Mailing Address - Country:US
Mailing Address - Phone:740-349-1001
Mailing Address - Fax:
Practice Address - Street 1:145 N QUENTIN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4623
Practice Address - Country:US
Practice Address - Phone:740-349-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist