Provider Demographics
NPI:1750144457
Name:BROOKS, SAGE KAE
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:KAE
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 1:1138 CROW PEAK LN
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-8624
Mailing Address - Country:US
Mailing Address - Phone:605-200-7243
Mailing Address - Fax:
Practice Address - Street 1:1138 CROW PEAK LN
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-8624
Practice Address - Country:US
Practice Address - Phone:605-200-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program