Provider Demographics
NPI:1144474172
Name:MEDLIN, BROOKE L (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:L
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BOHLEBER DR
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1501
Mailing Address - Country:US
Mailing Address - Phone:618-382-8084
Mailing Address - Fax:618-643-5304
Practice Address - Street 1:519 BOHLEBER DR
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1501
Practice Address - Country:US
Practice Address - Phone:618-382-8084
Practice Address - Fax:618-643-5304
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist