Provider Demographics
NPI:1235702218
Name:KNUTSON, BROOKE MACKENZIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MACKENZIE
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 PARSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-5316
Mailing Address - Country:US
Mailing Address - Phone:772-584-9075
Mailing Address - Fax:
Practice Address - Street 1:9711 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3817
Practice Address - Country:US
Practice Address - Phone:239-939-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2486231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist