Provider Demographics
NPI:1952768251
Name:MADISON, BROOKE LOUISE CAPP
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LOUISE CAPP
Last Name:MADISON
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 1:3340 SHARON PL
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3551
Mailing Address - Country:US
Mailing Address - Phone:847-293-0331
Mailing Address - Fax:
Practice Address - Street 1:175 NEWARK AVE
Practice Address - Street 2:SUITE 3RR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2859
Practice Address - Country:US
Practice Address - Phone:847-293-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00826400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist