Provider Demographics
NPI:1487903944
Name:BROKENS, EMILY CLAIRE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CLAIRE
Last Name:BROKENS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-9268
Mailing Address - Country:US
Mailing Address - Phone:414-581-6250
Mailing Address - Fax:
Practice Address - Street 1:3401 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8805
Practice Address - Country:US
Practice Address - Phone:414-581-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2023-0033235Z00000X
IA074630235Z00000X
IL146016072235Z00000X
WI3715-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist