1346315793 NPI number — MISS CARLA ANN BROOKS MA CCC-SLP

Table of content: MISS CARLA ANN BROOKS MA CCC-SLP (NPI 1346315793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346315793 NPI number — MISS CARLA ANN BROOKS MA CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
CARLA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346315793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7907 212TH ST SW
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98026-7525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-501-4856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7907 212TH ST SW
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-7525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-501-4856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL00001290 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 602-381-307 . This is a "UBI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7028319 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4761BR . This is a "REGENCE BLUESHIELD NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 83-0390536 . This is a "TAX ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 01023847 . This is a "ASHA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 261943001 . This is a "STATE TAX ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 46301 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7015157 . This is a "AETNA INSURANCE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8383796 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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