Provider Demographics
NPI:1861116790
Name:PRUTER, BROOKLYN HOPE
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:HOPE
Last Name:PRUTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:HOPE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BLDG 3031, CAMP HUMPHREYS
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 3031, INDIANHEAD AVE, USAG HUMPHREYS
Practice Address - Street 2:
Practice Address - City:PYEONGTAEK
Practice Address - State:GYEONGGI-DO
Practice Address - Zip Code:96271
Practice Address - Country:KR
Practice Address - Phone:503-337-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2487231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist