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General NPI Number Information
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NPI Number | 1215656012
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Entity Type | Individual
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Provider Name | BROOKE CORRIE RACKLEY
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 32 N MAIN ST
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City | FRANKLINVILLE
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State | NY
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Zip | 14737-1037
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Country | US
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Telephone | 716-676-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 612 CENTER ST
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City | EAST AURORA
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State | NY
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Zip | 14052-3040
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Country | US
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Telephone | 716-566-8284
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Fax |
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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 | 032238
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License Number State | NY
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