Healthcare Provider Details

I. General information

NPI: 1982212197
Provider Name (Legal Business Name): BROOKE MICHELLE HENSMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 INVERNESS CIR E UNIT H103
ENGLEWOOD CO
80112-5503
US

IV. Provider business mailing address

PO BOX 258831
OKLAHOMA CITY OK
73125-8831
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-3764
  • Fax:
Mailing address:
  • Phone: 720-961-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12472695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: