Provider Demographics
NPI:1366135394
Name:HOWARD, BROOKLYN R
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:R
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:R
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BROOKLYN ROBISON
Mailing Address - Street 1:13803 E COUNTY ROAD 300N
Mailing Address - Street 2:
Mailing Address - City:LERNA
Mailing Address - State:IL
Mailing Address - Zip Code:62440-2407
Mailing Address - Country:US
Mailing Address - Phone:217-508-9894
Mailing Address - Fax:
Practice Address - Street 1:13803 E COUNTY ROAD 300N
Practice Address - Street 2:
Practice Address - City:LERNA
Practice Address - State:IL
Practice Address - Zip Code:62440-2407
Practice Address - Country:US
Practice Address - Phone:217-508-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist