Provider Demographics
NPI:1952197600
Name:WILLIAMS, BROOKLYN MARIE
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11899 MACKEY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-7528
Mailing Address - Country:US
Mailing Address - Phone:605-210-2333
Mailing Address - Fax:
Practice Address - Street 1:11899 MACKEY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720-7528
Practice Address - Country:US
Practice Address - Phone:605-210-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer