1598540817 NPI number — MRS. BROOKE MARIE GARDINER-SMITH MS, LPC-IT

Table of content: MRS. BROOKE MARIE GARDINER-SMITH MS, LPC-IT (NPI 1598540817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598540817 NPI number — MRS. BROOKE MARIE GARDINER-SMITH MS, LPC-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDINER-SMITH
Provider First Name:
BROOKE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC-IT
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:
1598540817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 LINNERUD DR APT 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN PRAIRIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53590-3615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-778-7430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5944 SEMINOLE CENTER CTE.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-467-3467
Provider Business Practice Location Address Fax Number:
608-221-0885
Provider Enumeration Date:
08/25/2023

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: 101YM0800X , with the licence number:  7568-226 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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