Provider Demographics
NPI:1841022761
Name:BARTLING, BROOKE ASHLYNN
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLYNN
Last Name:BARTLING
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 1:958 S COMMUNITY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2082
Mailing Address - Country:US
Mailing Address - Phone:618-606-6298
Mailing Address - Fax:
Practice Address - Street 1:1400 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-4858
Practice Address - Country:US
Practice Address - Phone:618-233-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist