Provider Demographics
NPI:1730234105
Name:BROOKS, ELIZABETH EATON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EATON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 BEEHNON WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3193
Mailing Address - Country:US
Mailing Address - Phone:919-815-5373
Mailing Address - Fax:
Practice Address - Street 1:2604 BEEHNON WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3193
Practice Address - Country:US
Practice Address - Phone:919-438-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412506Medicaid