Healthcare Provider Details

I. General information

NPI: 1457832792
Provider Name (Legal Business Name): BROOKE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N SCHREIBER WAY UNIT 103
COEUR D ALENE ID
83815-8434
US

IV. Provider business mailing address

3815 N SCHREIBER WAY UNIT 103
COEUR D ALENE ID
83815-8434
US

V. Phone/Fax

Practice location:
  • Phone: 208-518-6551
  • Fax:
Mailing address:
  • Phone: 208-518-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5010
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3171960
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33780
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: