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General NPI Number Information
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NPI Number | 1144474172
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Entity Type | Individual
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Provider Name | BROOKE L MEDLIN M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 519 BOHLEBER DR
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City | CARMI
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State | IL
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Zip | 62821-1501
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Country | US
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Telephone | 618-382-8084
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Fax | 618-643-5304
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Provider Business Mailing Address
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Address Line | 519 BOHLEBER DR
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City | CARMI
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State | IL
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Zip | 62821-1501
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Country | US
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Telephone | 618-382-8084
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Fax | 618-643-5304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.000784
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License Number State | IL
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