Provider Demographics
NPI:1932821741
Name:BROOKS, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
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 1:311 ELM ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2781
Mailing Address - Country:US
Mailing Address - Phone:513-506-0061
Mailing Address - Fax:513-494-7882
Practice Address - Street 1:311 ELM ST STE 270
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2781
Practice Address - Country:US
Practice Address - Phone:513-506-0061
Practice Address - Fax:513-494-7882
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHJSC8690347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle