Provider Demographics
NPI:1063260339
Name:BROOKS, STACY LYNN
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 E 21ST ST N STE 900
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2975
Mailing Address - Country:US
Mailing Address - Phone:168-672-6833
Mailing Address - Fax:316-453-3487
Practice Address - Street 1:8340 E 21ST ST N STE 900
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2975
Practice Address - Country:US
Practice Address - Phone:168-672-6833
Practice Address - Fax:316-453-3487
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1964237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter