Provider Demographics
NPI:1578040986
Name:WITKEMPER, BROOKE (EARLY INTERVENTION)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WITKEMPER
Suffix:
Gender:F
Credentials:EARLY INTERVENTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 E COUNTY ROAD 820 S
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-9662
Mailing Address - Country:US
Mailing Address - Phone:812-593-1394
Mailing Address - Fax:
Practice Address - Street 1:2392 E COUNTY ROAD 820 S
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-9662
Practice Address - Country:US
Practice Address - Phone:812-593-1394
Practice Address - Fax:812-379-8992
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator