Healthcare Provider Details

I. General information

NPI: 1003731126
Provider Name (Legal Business Name): BROOK LYNN HOWLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 CLUB MANOR DR
PUEBLO CO
81008-2004
US

IV. Provider business mailing address

2062 W KEOTA DR
PUEBLO WEST CO
81007-2257
US

V. Phone/Fax

Practice location:
  • Phone: 719-696-7799
  • Fax:
Mailing address:
  • Phone: 719-696-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-503090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: