Provider Demographics
NPI:1306538764
Name:HAESSIG, BROOKE LAUREN (MA CF-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LAUREN
Last Name:HAESSIG
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MAXWELL ST
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50161-2017
Mailing Address - Country:US
Mailing Address - Phone:319-330-2207
Mailing Address - Fax:
Practice Address - Street 1:5530 WEST PKWY STE 300
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2258
Practice Address - Country:US
Practice Address - Phone:427-051-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist