Provider Demographics
NPI:1205316031
Name:BLOKER, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BLOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BLOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3900 FOUNTAINS BLVD NE STE 203
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-6610
Mailing Address - Country:US
Mailing Address - Phone:319-734-2002
Mailing Address - Fax:319-734-2003
Practice Address - Street 1:1226 W ASH ST UNIT C
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4657
Practice Address - Country:US
Practice Address - Phone:319-939-7558
Practice Address - Fax:319-939-7558
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
IA110913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health