Healthcare Provider Details

I. General information

NPI: 1952235541
Provider Name (Legal Business Name): KELSEY DAJANNE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053-3821
US

IV. Provider business mailing address

6140 S BROADWAY
LORAIN OH
44053-3821
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-7232
  • Fax: 440-233-9077
Mailing address:
  • Phone: 440-233-7232
  • Fax: 440-233-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: