1841523008 NPI number — BROOKE AMY CUNNINGHAM MA, CCC-SLP

Table of content: BROOKE AMY CUNNINGHAM MA, CCC-SLP (NPI 1841523008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841523008 NPI number — BROOKE AMY CUNNINGHAM MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
BROOKE
Provider Middle Name:
AMY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
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:
1841523008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1187 E KETTLE PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-912-2910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11479 PINE DR # 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134-7308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-840-6374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2009

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: 235Z00000X , with the licence number:  12089448 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 53508572 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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