Brooke L Wilson, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA11587 Issued in FL

Practice address

1143 Salt Creek Drive
Ponte Vedra Beach, FL 32082

Phone

(321) 230-3800

NPI assigned

Sep 1, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Brooke Davis Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521763200000",
    "number": "1255612446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 SALT CREEK DRIVE",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "904-318-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 SALT CREEK DRIVE",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "321-230-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "807 Childrens Way",
            "address_2": "Nemours Childrens Clinic, Jacksonville",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322078426",
            "country_code": "US",
            "telephone_number": "904-697-3600",
            "fax_number": "904-697-3792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BROOKE",
        "middle_name": "L",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-01",
        "last_updated": "2018-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ5331",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA11587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010224300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "DAVIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Scott David Wiedenmann, M.D.
• Brook Wiley
• Kearra Williams
• Trina Renee Williams, ARNP
• Stephen Williamson, DPT
• Neykisha Wilson
• Roger L. Wilson, O.D.
• Hilary Windsor, MS, CCC-SLP
• Nicole Lee Winter, PSY.D.
• John Theodore Woeste Jr., MD

• Speech-Language Pathologist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.