Provider Demographics
NPI:1104293430
Name:GALISZEWSKI, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GALISZEWSKI
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 1:2241 GREEN HEDGES WAY
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6966
Mailing Address - Country:US
Mailing Address - Phone:813-973-1033
Mailing Address - Fax:813-200-9608
Practice Address - Street 1:2241 GREEN HEDGES WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6966
Practice Address - Country:US
Practice Address - Phone:813-973-1033
Practice Address - Fax:813-200-9608
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015734300Medicaid