Individual
BROOKE ELIZABETH FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
8254 118TH AVE STE 100, LARGO, FL 33773-5027
(727) 541-5304
Mailing address
3015 S YSABELLA AVE APT F, TAMPA, FL 33629-8160
(813) 244-7616
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA18082
FL
235Z00000X
Speech-Language Pathologist
SZ9314
FL
Other
Enumeration date
09/24/2019
Last updated
07/23/2020
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