Provider Demographics
NPI:1265786164
Name:BROOKS, M. YVONNE (MA-CCC/SLP)
Entity type:Individual
Prefix:
First Name:M.
Middle Name:YVONNE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:M
Other - Middle Name:YVONNE
Other - Last Name:WERNICKE-BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:19705 88TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:425-408-5583
Mailing Address - Fax:425-408-5572
Practice Address - Street 1:19705 88TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2121
Practice Address - Country:US
Practice Address - Phone:425-408-5583
Practice Address - Fax:425-408-5572
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00001572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist