MEDICARE: BROOKE J TRUEBLOOD SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	11173	MD
2	235Z00000X	Speech-Language Pathologist	146028564	IL
3	235Z00000X	Speech-Language Pathologist	22007749A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396275137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE J TRUEBLOOD SLP

Provider Business Mailing Address
First Line	:	2906 HIGHWAY AVE
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1631
Country	:	US
Telephone Number	:	219-513-8311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 HIGHWAY AVE
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1631
Country	:	US
Telephone Number	:	219-513-8311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	05/13/2026

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Directions to “ BROOKE J TRUEBLOOD SLP” Practice Location

Language	Start Address	Practice Location

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