Provider Demographics
NPI:1215656012
Name:RACKLEY, BROOKE CORRIE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CORRIE
Last Name:RACKLEY
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 1:612 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-3040
Mailing Address - Country:US
Mailing Address - Phone:716-566-8284
Mailing Address - Fax:
Practice Address - Street 1:32 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NY
Practice Address - Zip Code:14737-1037
Practice Address - Country:US
Practice Address - Phone:716-676-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist