Provider Demographics
NPI:1699289082
Name:SORRELLS, BROOKE TERRY (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:TERRY
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:505 BALSAM TERRACE WAY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-3509
Mailing Address - Country:US
Mailing Address - Phone:256-286-5318
Mailing Address - Fax:256-517-9528
Practice Address - Street 1:1101 MCMURTRIE DR NW STE G1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2471
Practice Address - Country:US
Practice Address - Phone:256-286-5318
Practice Address - Fax:256-517-9528
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
14093036235Z00000X
AL3936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL274353Medicaid