Provider Demographics
NPI:1770094781
Name:BROOKS-NOWAK, JAMIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BROOKS-NOWAK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1580
Mailing Address - Country:US
Mailing Address - Phone:716-597-8353
Mailing Address - Fax:
Practice Address - Street 1:174 HIGH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1580
Practice Address - Country:US
Practice Address - Phone:716-597-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist