Healthcare Provider Details

I. General information

NPI: 1235389842
Provider Name (Legal Business Name): BROOKE POLCYN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E WASHINGTON ST STE 1A
APPLETON WI
54911-5447
US

IV. Provider business mailing address

N9015 SWEETGRASS TRL
MENASHA WI
54952-2385
US

V. Phone/Fax

Practice location:
  • Phone: 920-852-5440
  • Fax:
Mailing address:
  • Phone: 920-205-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3140-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: