Provider Demographics
NPI:1982939690
Name:BROOKS, LINDA T (SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:BROOKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4154
Mailing Address - Country:US
Mailing Address - Phone:318-686-8934
Mailing Address - Fax:
Practice Address - Street 1:5609 CROSS TIMBERS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3605
Practice Address - Country:US
Practice Address - Phone:318-393-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist