=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811882178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE NIELSEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 OLD ROCKY RIDGE RD STE 100
-----------------------------------------------------
City | VESTAVIA HILLS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35216-7251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-978-9939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 BRADFORD CIR
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-23-318145
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------