Provider Demographics
NPI:1902421910
Name:BROOKS, MEREDITH HOPE (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:HOPE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINDING WOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7820
Mailing Address - Country:US
Mailing Address - Phone:864-414-4898
Mailing Address - Fax:
Practice Address - Street 1:229 KENMORE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8253
Practice Address - Country:US
Practice Address - Phone:803-319-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist