MEDICARE: BROOKELYN SCHWARTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2020023630	MO

General Provider Information

NPI Number	:	1083211213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKELYN SCHWARTZ

Provider Business Mailing Address
First Line	:	93 OAK RIDGE TRL
Second Line	:
City	:	FREEBURG
State	:	MO
Zip	:	65035-2046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 LEWIS AND CLARK DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-5586
Country	:	US
Telephone Number	:	573-659-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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Directions to “ BROOKELYN SCHWARTZ ” Practice Location

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