Provider Demographics
NPI:1598278103
Name:STAMM, BROOKE NORINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NORINE
Last Name:STAMM
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 1:1154 COUNTY ROAD 1800 N
Mailing Address - Street 2:
Mailing Address - City:LOWPOINT
Mailing Address - State:IL
Mailing Address - Zip Code:61545-7511
Mailing Address - Country:US
Mailing Address - Phone:309-220-8130
Mailing Address - Fax:
Practice Address - Street 1:110 W MOUNT VERNON ST STE 3
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-7095
Practice Address - Country:US
Practice Address - Phone:309-220-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14196483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist