MEDICARE: MRS. BROOKE NICOLE ROSENTHAL M.S. CCC-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	146008327	IL

General Provider Information

NPI Number	:	1679091672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE NICOLE ROSENTHAL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	8293 MINE AVE
Second Line	:
City	:	MORRISONVILLE
State	:	IL
Zip	:	62546-6010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 ROCKET DR
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9282
Country	:	US
Telephone Number	:	217-498-9778
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	08/30/2017

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Directions to “ MRS. BROOKE NICOLE ROSENTHAL M.S. CCC-SLP” Practice Location

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