Provider Demographics
NPI:1750685020
Name:BROOKS, JACQUELINE RENEA
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:RENEA
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 1:3021 LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2211
Mailing Address - Country:US
Mailing Address - Phone:972-271-0596
Mailing Address - Fax:972-271-0596
Practice Address - Street 1:3021 LINCOLN CT
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2211
Practice Address - Country:US
Practice Address - Phone:972-271-0596
Practice Address - Fax:972-271-0596
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services