Provider Demographics
NPI:1023774767
Name:LOWERY, BROOKE LEWIS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEWIS
Last Name:LOWERY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 RUDY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2347
Mailing Address - Country:US
Mailing Address - Phone:270-316-3037
Mailing Address - Fax:
Practice Address - Street 1:6830 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6579
Practice Address - Country:US
Practice Address - Phone:502-423-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist