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NPI Code Detail

MEDICARE: JACQUELINE BROOKS M.ED., CCC-SLP

MEDICARE: JACQUELINE BROOKS M.ED., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist22002084AIN

General Provider Information

NPI Number : 1710409933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BROOKS M.ED., CCC-SLP
Provider Business Mailing Address
First Line : 7902 CROSSHILL CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-3191
Country : US
Telephone Number : 260-615-3966
Fax Number :
Provider Business Practice Location Address
First Line : 7902 CROSSHILL CT
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-3191
Country : US
Telephone Number : 260-615-3966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2017
Last Update Date : 07/21/2022

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Directions to “ JACQUELINE BROOKS M.ED., CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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