Active NPI
Brooke Lolley, SLP
- Speech-Language Pathologist
- Fort Walton Beach, FL
National Provider Identifier
1609402965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 8376 | LA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Treehouse Therapies, LLC | Speech-Language Pathologist | Current | Accepting new patients |
| Melanie Massey Infant & Toddler LLC | Speech-Language Pathologist | Past | Accepting new patients |
| Treehouse Therapies, LLC | Speech-Language Pathologist | Past | 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.
-
- Pediatric Physical Therapist
- Fort Walton Beach, FL
- NPI 1083380828
Speech-Language Pathologist
-
- Speech-Language Pathologist
- Fort Walton Beach, FL
- NPI 1972800639
-
- Speech-Language Pathologist
- West Monroe, LA
- NPI 1447453865
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.