Healthcare Provider Details

I. General information

NPI: 1124958210
Provider Name (Legal Business Name): REBECCA BROUILLET
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MILES ST
CHIPPEWA FALLS WI
54729-1923
US

IV. Provider business mailing address

1130 MILES ST
CHIPPEWA FALLS WI
54729-1923
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-2417
  • Fax: 715-726-2781
Mailing address:
  • Phone: 715-726-2417
  • Fax: 715-726-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: