Jaclyn Brothers

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP10555 Issued in AZ

Practice address

845 S Crismon Rd
Mesa, AZ 85208-2564

Phone

(480) 472-9400

NPI assigned

Jun 11, 2017

Last updated

Jul 21, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1497139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194254235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 E SHEA BLVD STE 600",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852686663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S CRISMON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852082564",
            "telephone_number": "480-472-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30803 Mainmast Dr",
            "address_purpose": "LOCATION",
            "city": "Agoura Hills",
            "state": "CA",
            "postal_code": "913011937",
            "country_code": "US",
            "telephone_number": "818-429-4126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7301 E Brown Rd",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852073803",
            "country_code": "US",
            "telephone_number": "480-472-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROTHERS",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP10555",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP25120",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alec Brotherton, HIS
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• Brown Road Dental Partners LLC (Brown Road Dental)
• Brown Road Family Medicine, PLLC
• Brown Road Senior Housing, LLC (Grand Court Mesa)

• Speech-Language Pathologist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.