Provider Demographics
NPI:1912331075
Name:HEWITT, BROOKE ELISE (MS SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ELISE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:706A W BEN WHITE BLVD
Mailing Address - Street 2:SUITE #150A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7144
Mailing Address - Country:US
Mailing Address - Phone:512-441-5100
Mailing Address - Fax:512-441-5108
Practice Address - Street 1:706A W BEN WHITE BLVD
Practice Address - Street 2:SUITE #150A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7144
Practice Address - Country:US
Practice Address - Phone:512-441-5100
Practice Address - Fax:512-441-5108
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist