Individual provider Active NPI

Brooke Lolley, SLP

  • Speech-Language Pathologist
  • Fort Walton Beach, FL
National Provider Identifier
1609402965
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
24 Hollywood Blvd SW Ste 7
Fort Walton Beach, FL 32548-4893
Phone
(850) 226-7411
Fax
(850) 226-7496
NPI assigned
Mar 19, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 8376 LA
Speech-Language Pathologist 235Z00000X FL Primary

Addresses

Primary practice location

24 Hollywood Blvd SW Ste 7
Fort Walton Beach, FL 32548-4893

Mailing address

24 Hollywood Blvd SW Ste 7
Fort Walton Beach, FL 32548-4893
Phone (850) 226-7411

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
8376LAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Treehouse Therapies, LLC Speech-Language Pathologist CurrentSince Mar 13, 2022 Accepting new patients
Melanie Massey Infant & Toddler LLC Speech-Language Pathologist PastSince Mar 22, 2020 Accepting new patients
Treehouse Therapies, LLC Speech-Language Pathologist PastSince Mar 13, 2022 Accepting new patients

Locations

24 Hollywood Blvd SW
Ste 7
Fort Walton Beach, FL 32548
Phone (850) 226-7411

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1609402965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HOLLYWOOD BLVD SW STE 7",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325484893",
            "telephone_number": "850-226-7411",
            "fax_number": "850-226-7496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 HOLLYWOOD BLVD SW STE 7",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325484893",
            "telephone_number": "850-226-7411",
            "fax_number": "850-226-7496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOLLEY",
        "first_name": "BROOKE",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "8376",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.