Healthcare Provider Details

I. General information

NPI: 1225312077
Provider Name (Legal Business Name): BROOKE WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S BURLINGTON AVE STE 110
HASTINGS NE
68901-6928
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2077
  • Fax: 402-463-2062
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1479
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: