Healthcare Provider Details

I. General information

NPI: 1962349126
Provider Name (Legal Business Name): BROOKE CRAIG SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W MONTROSE AVE
CHICAGO IL
60618-1521
US

IV. Provider business mailing address

2716 W MONTROSE AVE
CHICAGO IL
60618-1521
US

V. Phone/Fax

Practice location:
  • Phone: 312-690-9005
  • Fax:
Mailing address:
  • Phone: 312-690-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018566
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: