Provider Demographics
NPI:1427327733
Name:CROKE, BROOK D (MS, CGC)
Entity type:Individual
Prefix:MRS
First Name:BROOK
Middle Name:D
Last Name:CROKE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4462
Mailing Address - Country:US
Mailing Address - Phone:855-776-9436
Mailing Address - Fax:
Practice Address - Street 1:400 N. 9TH STREET
Practice Address - Street 2:3RD FLOOR CLINIC B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-9759
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246-000143170300000X
IL246.000143170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS