Provider Demographics
NPI:1427778612
Name:WHITTINGTON, BROOKE NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ELKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62932-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HERITAGE WOODS OF CENTRALIA
Practice Address - Street 2:2049 EAST MCCORD ST.
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-439-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist