Provider Demographics
NPI:1851861405
Name:RUBERG, BROOKE (SLP)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:RUBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN LIGHTS SERVICES INC
Mailing Address - Street 2:706 BRATLEY DRIVE
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891
Mailing Address - Country:US
Mailing Address - Phone:715-373-6425
Mailing Address - Fax:715-373-5655
Practice Address - Street 1:NORTHERN LIGHTS SERVICES INC
Practice Address - Street 2:706 BRATLEY DRIVE
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891
Practice Address - Country:US
Practice Address - Phone:715-373-6425
Practice Address - Fax:715-373-5655
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4539-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist