Provider Demographics
NPI:1699380006
Name:BRUTUS, RACHEL LOUISE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LOUISE
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S UNION ST APT 313
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6066
Mailing Address - Country:US
Mailing Address - Phone:765-860-0822
Mailing Address - Fax:
Practice Address - Street 1:1805 E HOFFER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2443
Practice Address - Country:US
Practice Address - Phone:765-450-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006193A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist