Provider Demographics
NPI:1154759835
Name:BROOKS, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W NORFOLK AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5006
Mailing Address - Country:US
Mailing Address - Phone:402-379-1490
Mailing Address - Fax:
Practice Address - Street 1:900 W NORFOLK AVE
Practice Address - Street 2:STE. 200
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5006
Practice Address - Country:US
Practice Address - Phone:402-379-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator