Provider Demographics
NPI:1033612312
Name:FISCHER, BROOKE M (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BARNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5971
Mailing Address - Country:US
Mailing Address - Phone:573-275-4618
Mailing Address - Fax:
Practice Address - Street 1:1525 BARNWOOD CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5971
Practice Address - Country:US
Practice Address - Phone:573-275-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist