Doctor Name: | MS. BROOKE RANDOLPH |
NPI Number: | 1437425295 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 007746 |
Business Practice Address: | 301 Heritage Walk Ste 101 Woodstock, GA - 301886450 |
Business Phone Number: | 7705915852 |
Business Fax Number: | 7705915957 |
Mailing Address: | 301 Heritage Walk Ste 101, WOODSTOCK |
State: | GA |
Postal Code: | 301886450 |
Phone Number: | 7705915852 |
Fax Number: | 7705915957 |
NPI Enumeration Date: | 03/27/2012 |
NPI Last Update Date: | 03/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 007746 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |