Healthcare Provider Details

I. General information

NPI: 1386804847
Provider Name (Legal Business Name): BROOKE ELIZABETH FALLON AUD CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 STEPHENSON HWY SUITE 400-CREDENTIALING
TROY MI
48083-1189
US

IV. Provider business mailing address

1135 W UNIVERSITY DR CRITTENTON HOSPITAL SUITE 440
ROCHESTER MI
48307-1897
US

V. Phone/Fax

Practice location:
  • Phone: 248-581-5974
  • Fax: 248-581-5640
Mailing address:
  • Phone: 248-218-5557
  • Fax: 248-218-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: