Provider Demographics
NPI:1992384440
Name:BROOKS, ABBEY
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
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 1:1070 UNIVERSITY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5546
Mailing Address - Country:US
Mailing Address - Phone:618-335-2026
Mailing Address - Fax:
Practice Address - Street 1:1070 UNIVERSITY DR APT 4
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-5546
Practice Address - Country:US
Practice Address - Phone:618-335-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist