Provider Demographics
NPI:1386804847
Name:FALLON, BROOKE ELIZABETH (AUD CCC-A)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:FALLON
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Gender:F
Credentials:AUD CCC-A
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Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:CRITTENTON HOSPITAL SUITE 440
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1897
Mailing Address - Country:US
Mailing Address - Phone:248-218-5557
Mailing Address - Fax:248-218-5588
Practice Address - Street 1:1420 STEPHENSON HWY
Practice Address - Street 2:SUITE 400-CREDENTIALING
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1189
Practice Address - Country:US
Practice Address - Phone:248-581-5974
Practice Address - Fax:248-581-5640
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2013-12-20
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Provider Licenses
StateLicense IDTaxonomies
MI1601000495231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P46750007Medicare PIN