Provider Demographics
NPI:1326301896
Name:ELARDI, BROOKE NOELL
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:NOELL
Last Name:ELARDI
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:PO BOX 1642
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-1642
Mailing Address - Country:US
Mailing Address - Phone:307-789-0664
Mailing Address - Fax:307-789-1902
Practice Address - Street 1:1425 STATE HIGHWAY 150 S
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5377
Practice Address - Country:US
Practice Address - Phone:307-789-0664
Practice Address - Fax:307-789-1902
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171M00000XOther Service ProvidersCase Manager/Care Coordinator