Provider Demographics
NPI:1033600598
Name:BROOKS, BREEONIE D
Entity Type:Individual
Prefix:MRS
First Name:BREEONIE
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 23RD ST SW
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3879
Mailing Address - Country:US
Mailing Address - Phone:330-812-4782
Mailing Address - Fax:
Practice Address - Street 1:2217 23RD ST SW
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3879
Practice Address - Country:US
Practice Address - Phone:330-812-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health