1225841067 NPI number — DEBORAH A PRICE-BROOKS BS, BIOLOGY: RBT

Table of content: DEBORAH A PRICE-BROOKS BS, BIOLOGY: RBT (NPI 1225841067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225841067 NPI number — DEBORAH A PRICE-BROOKS BS, BIOLOGY: RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE-BROOKS
Provider First Name:
DEBORAH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, BIOLOGY: RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225841067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8957 S EMERALD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60620-2635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-996-3413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 S HARLEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORTH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60482-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-586-2604
Provider Business Practice Location Address Fax Number:
866-823-8780
Provider Enumeration Date:
01/27/2025

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: 106S00000X , with the licence number:  BACB1172778 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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