Provider Demographics
NPI:1780889329
Name:VERSCHAGE, BROOKE S (AUD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:S
Last Name:VERSCHAGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:N
Other - Last Name:SCHOEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJAX - OTOLARYNGOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4267
Practice Address - Fax:904-244-7730
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1414231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA468759749AMedicaid
FL6005349-00Medicaid
FL6005349-00Medicaid