Provider Demographics
NPI:1285324103
Name:ASHLEY, BROOKE ALISON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALISON
Last Name:ASHLEY
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 1:107 GARDEN WALK LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5979
Mailing Address - Country:US
Mailing Address - Phone:936-222-6326
Mailing Address - Fax:
Practice Address - Street 1:1400 W AUSTIN ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-3620
Practice Address - Country:US
Practice Address - Phone:936-544-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist