Healthcare Provider Details

I. General information

NPI: 1952220147
Provider Name (Legal Business Name): BROOKLYNN CARLSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7755 OFFICE PLAZA DR N
WEST DES MOINES IA
50266-2339
US

IV. Provider business mailing address

807 N C ST
INDIANOLA IA
50125-1324
US

V. Phone/Fax

Practice location:
  • Phone: 515-808-8296
  • Fax:
Mailing address:
  • Phone: 515-808-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: