Provider Demographics
NPI:1265040695
Name:EDGREN, BROOKE CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CHRISTINE
Last Name:EDGREN
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68937-0107
Mailing Address - Country:US
Mailing Address - Phone:308-785-2491
Mailing Address - Fax:
Practice Address - Street 1:502 1ST AVE
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:NE
Practice Address - Zip Code:68937-5208
Practice Address - Country:US
Practice Address - Phone:308-785-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist