Provider Demographics
NPI:1447818703
Name:LOMBAARD, BROOKE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:LOMBAARD
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 CORAL HEIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5225
Mailing Address - Country:US
Mailing Address - Phone:954-756-1003
Mailing Address - Fax:
Practice Address - Street 1:1955 N FEDERAL HWY UNIT 253
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1036
Practice Address - Country:US
Practice Address - Phone:954-580-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist