Healthcare Provider Details

I. General information

NPI: 1043683857
Provider Name (Legal Business Name): BROOKE N KUCKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W RIVER AVE
BARRON WI
54812-1052
US

IV. Provider business mailing address

100 W RIVER AVE
BARRON WI
54812-1052
US

V. Phone/Fax

Practice location:
  • Phone: 715-537-5612
  • Fax:
Mailing address:
  • Phone: 715-537-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4122-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: