MEDICARE: IVANA DJORDJEVIC BROOKS

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	103K00000X	Behavior Analyst	1898	NC

General Provider Information

NPI Number	:	1427521277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANA DJORDJEVIC BROOKS

Provider Business Mailing Address
First Line	:	725 RIDGELINE DR UNIT 227
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-9515
Country	:	US
Telephone Number	:	757-343-6803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 HIGHWAY 160 W
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8024
Country	:	US
Telephone Number	:	512-615-5186
Fax Number	:

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	12/16/2025

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Directions to “ IVANA DJORDJEVIC BROOKS ” Practice Location

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