Active NPI
Brooke Polk, M.S., CCC-SLP
- Speech-Language Pathologist
- Haughton, LA
National Provider Identifier
1407178155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP#2164
- Practice address
- 1912 Sparrowridge Cir
Haughton, LA 71037-7714 - Phone
- (501) 413-1393
- NPI assigned
- Feb 23, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP#2164 | AR | Primary |
Addresses
Primary practice location
1912 Sparrowridge Cir
Haughton, LA 71037-7714
Mailing address
1912 Sparrowridge Cir
Haughton, LA 71037-7714
Phone (501) 413-1393
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180245721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP#2164 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421884800000",
"number": "1407178155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1912 SPARROWRIDGE CIR",
"city": "HAUGHTON",
"state": "LA",
"postal_code": "710377714",
"telephone_number": "501-413-1393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1912 SPARROWRIDGE CIR",
"city": "HAUGHTON",
"state": "LA",
"postal_code": "710377714",
"telephone_number": "501-413-1393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLK",
"first_name": "BROOKE",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-23",
"last_updated": "2015-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "SP#2164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180245721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Haughton, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.