Healthcare Provider Details

I. General information

NPI: 1972422939
Provider Name (Legal Business Name): BROOKE RAELYN DAMMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-8700
US

IV. Provider business mailing address

2121 1/2 VERMILION RD
DULUTH MN
55803-2215
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-5954
  • Fax: 480-704-5807
Mailing address:
  • Phone: 763-412-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: