Provider Demographics
NPI:1447977004
Name:CARLSON, BROOKE LINDSEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LINDSEY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1565
Mailing Address - Country:US
Mailing Address - Phone:814-771-8392
Mailing Address - Fax:
Practice Address - Street 1:433 S CARLISLE ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1565
Practice Address - Country:US
Practice Address - Phone:814-771-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist