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
1	235Z00000X	Speech-Language Pathologist	22002084A	IN

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

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