Provider Demographics
NPI:1447741202
Name:BROOKS, RACHEL ELISABETH
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELISABETH
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 1:1717 SW PARK AVE APT 817
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3240
Mailing Address - Country:US
Mailing Address - Phone:469-371-4747
Mailing Address - Fax:
Practice Address - Street 1:1023 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1917
Practice Address - Country:US
Practice Address - Phone:541-926-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist