Healthcare Provider Details

I. General information

NPI: 1811882178
Provider Name (Legal Business Name): BROOKE NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 OLD ROCKY RIDGE RD STE 100
VESTAVIA HILLS AL
35216-7251
US

IV. Provider business mailing address

313 BRADFORD CIR
TRUSSVILLE AL
35173-3230
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-9939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-318145
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: