Provider Demographics
NPI:1306582861
Name:MARSHALL, BROOKE
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:GIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 W. LONG LAKE ROAD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-214-7755
Mailing Address - Fax:248-940-2739
Practice Address - Street 1:800 W. LONG LAKE ROAD
Practice Address - Street 2:SUITE 195
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-214-7755
Practice Address - Fax:248-940-2739
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008809235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist