Provider Demographics
NPI:1902397896
Name:RUXTON, BROOKE MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:RUXTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 STOUGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-6478
Mailing Address - Country:US
Mailing Address - Phone:515-508-9992
Mailing Address - Fax:
Practice Address - Street 1:2385 STOUGHTON CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6478
Practice Address - Country:US
Practice Address - Phone:515-508-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist