Healthcare Provider Details

I. General information

NPI: 1568017853
Provider Name (Legal Business Name): BROOKE FRAZER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LOCUST ST
ELDORADO IL
62930-1723
US

IV. Provider business mailing address

1315 GENESTA DR
EVANSVILLE IN
47720-6217
US

V. Phone/Fax

Practice location:
  • Phone: 618-252-9036
  • Fax:
Mailing address:
  • Phone: 812-622-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: