Kenna Marie Brooks

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

612 Woodland Square Loop SE Ste 401
Lacey, WA 98503-1070

Phone

(360) 999-9053

NPI assigned

Jul 14, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Olympic Health and Recovery Services

  • Community/Behavioral Health Agency
  • Lacey, WA
  • NPI 1760007504
  NPD (past)
• Thurston Mason Behavioral Health Organization

  • Community/Behavioral Health Agency
  • Lacey, WA
  • NPI 1265932198
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551398400000",
    "number": "1033631668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9611 WASHINGTON BLVD SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984981248",
            "telephone_number": "928-503-5422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031070",
            "telephone_number": "360-999-9053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "908 5th Ave SE",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985011507",
            "country_code": "US",
            "telephone_number": "360-754-2423 x078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "KENNA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-14",
        "last_updated": "2019-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WA",
            "license": "CG60792062",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033631668",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TELECARE MOBILE OUTREACH TEAM",
            "identifier": "1780913657",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Marie Brockl, MS CCC-SLP
• Rebecca Broderick, ACNPC-AG, BSN, RN
• Hillary Marie Brodin
• David Shane Brodsky
• Haley Brooks
• Tara Annette Brooks, LMHC
• Brooke Brooling
• Kylie Broome, PHARM D
• Broughton Dunn PLLC
• Arrie Jeanine Brown

• Peer Specialist in Lacey, WA
• Providers in Lacey, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.