Provider Demographics
NPI:1851699276
Name:PARKER, BROOKE OWENS (BROOKE OWENS PARKER)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:OWENS
Last Name:PARKER
Suffix:
Gender:F
Credentials:BROOKE OWENS PARKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S DREXEL BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3328
Mailing Address - Country:US
Mailing Address - Phone:601-946-3086
Mailing Address - Fax:
Practice Address - Street 1:4101 S DREXEL BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3328
Practice Address - Country:US
Practice Address - Phone:601-946-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11210247103K00000X
MS801407948103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst