Provider Demographics
NPI:1023297348
Name:BRAKKE, ROSE I (AUD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:I
Last Name:BRAKKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:I
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3139 BLUE STEM DR STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8060
Mailing Address - Country:US
Mailing Address - Phone:701-639-4595
Mailing Address - Fax:701-639-6979
Practice Address - Street 1:3139 BLUE STEM DR STE 108
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8060
Practice Address - Country:US
Practice Address - Phone:701-639-4595
Practice Address - Fax:701-639-6979
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND989231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist