Provider Demographics
NPI:1710610902
Name:DURR, BROOKE ANGELLE (MCD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANGELLE
Last Name:DURR
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 JEFFERSON HWY
Mailing Address - Street 2:PMB 127
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8308
Mailing Address - Country:US
Mailing Address - Phone:225-717-3958
Mailing Address - Fax:
Practice Address - Street 1:7515 JEFFERSON HWY
Practice Address - Street 2:PMB 127
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8308
Practice Address - Country:US
Practice Address - Phone:225-717-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist