Provider Demographics
NPI:1144656042
Name:BROOKS SPEECH LANGUAGE THERAPY SERVICES
Entity type:Organization
Organization Name:BROOKS SPEECH LANGUAGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:321-501-0282
Mailing Address - Street 1:1117 TAPP RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6844
Mailing Address - Country:US
Mailing Address - Phone:321-501-0282
Mailing Address - Fax:
Practice Address - Street 1:1117 TAPP RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6844
Practice Address - Country:US
Practice Address - Phone:321-501-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP 487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56203OtherBLUE CROSS BLUE SHIELD
AR116145721Medicaid