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General NPI Number Information
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NPI Number | 1487903944
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Entity Type | Individual
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Provider Name | EMILY CLAIRE BROKENS MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 3401 E 30TH ST
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City | FARMINGTON
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State | NM
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Zip | 87402-8805
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Country | US
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Telephone | 414-581-6250
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Fax |
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Provider Business Mailing Address
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Address Line | 9128 PHEASANT LN
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City | DUBUQUE
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State | IA
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Zip | 52003-9268
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Country | US
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Telephone | 414-581-6250
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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 | SAH-2023-0033
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 074630
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146016072
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3715-154
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License Number State | WI
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