Provider Demographics
NPI:1639896889
Name:JAKSE, BROOKLYN ROSE
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:ROSE
Last Name:JAKSE
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 1:2084 ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-9639
Mailing Address - Country:US
Mailing Address - Phone:630-864-7441
Mailing Address - Fax:
Practice Address - Street 1:2084 ROCKWELL RD
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-9639
Practice Address - Country:US
Practice Address - Phone:630-864-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist