MEDICARE: BROOKE WEST

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	1479	NE

General Provider Information

NPI Number	:	1225312077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE WEST

Provider Business Mailing Address
First Line	:	PO BOX 5285
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68802-5285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 S BURLINGTON AVE STE 110
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-6928
Country	:	US
Telephone Number	:	402-463-2077
Fax Number	:	402-463-2062

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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1235665886 — MS. JORDYN LEA KEASLING LCSW
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Directions to “ BROOKE WEST ” Practice Location

Language	Start Address	Practice Location

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