Provider Demographics
NPI:1720125784
Name:BROOKS, REBECCA P (MA CCCA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 UNIVERSITY BLVD E RM 145
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0001
Mailing Address - Country:US
Mailing Address - Phone:205-348-7131
Mailing Address - Fax:205-348-1845
Practice Address - Street 1:700 UNIVERSITY BLVD E RM 145
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-7131
Practice Address - Fax:205-348-1845
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL591A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009100860Medicaid