Provider Demographics
NPI:1982481867
Name:PITTMAN, BROOKE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ANN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 DEBBIE LN UNIT 401
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5030
Mailing Address - Country:US
Mailing Address - Phone:979-277-2657
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER STEPHENSON RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3699
Practice Address - Country:US
Practice Address - Phone:469-856-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist