1760602536 NPI number — ABIGAIL AILEEN BROOKS LICSW

Table of content: ABIGAIL AILEEN BROOKS LICSW (NPI 1760602536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760602536 NPI number — ABIGAIL AILEEN BROOKS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
ABIGAIL
Provider Middle Name:
AILEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OCKWIG
Provider Other First Name:
AILEEN
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760602536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17057 EAGLEVIEW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55024-7304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-913-6590
Provider Business Mailing Address Fax Number:
507-206-2573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 WOOD LAKE SE
Provider Second Line Business Practice Location Address:
ROCHESTER COMMUNITY BEHAVIORAL HEALTH HOSPITAL
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-206-2573
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10607 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)