MEDICARE: BROOKE TEDFORD

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	031-SLP	SD

General Provider Information

NPI Number	:	1548679707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE TEDFORD

Provider Business Mailing Address
First Line	:	5509 SUNBURST DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8801
Country	:	US
Telephone Number	:	605-381-0776
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 SUNBURST DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8801
Country	:	US
Telephone Number	:	605-381-0776
Fax Number	:

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

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	02/13/2026

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Directions to “ BROOKE TEDFORD ” Practice Location

Language	Start Address	Practice Location

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