Individual
MISS CARLA ANN BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
7907 212TH ST SW, STE 105, EDMONDS, WA 98026-7525
(425) 501-4856
Mailing address
7907 212TH ST SW, STE 105, EDMONDS, WA 98026-7525
(425) 501-4856
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00001290
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01023847
ASHA
WA
01
—
261943001
STATE TAX ID
WA
05
—
46301
—
WA
01
—
4761BR
REGENCE BLUESHIELD NUMBER
WA
01
—
602-381-307
UBI
WA
01
—
7015157
AETNA INSURANCE NUMBER
WA
05
—
7028319
—
WA
01
—
83-0390536
TAX ID #
WA
05
—
8383796
—
WA
Enumeration date
11/21/2006
Last updated
06/11/2008
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