Provider Demographics
NPI:1932518313
Name:BEHM, BROOKE E (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:E
Last Name:BEHM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 TULIP DR
Mailing Address - Street 2:
Mailing Address - City:MACKINAW
Mailing Address - State:IL
Mailing Address - Zip Code:61755-8500
Mailing Address - Country:US
Mailing Address - Phone:309-840-2150
Mailing Address - Fax:
Practice Address - Street 1:275 ILLINOIS STATE UNIV
Practice Address - Street 2:211 RACHEL COOPER
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-0001
Practice Address - Country:US
Practice Address - Phone:309-840-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist