Active NPI
Jacqueline Brooks, M.ED., CCC-SLP
- Speech-Language Pathologist
- Fort Wayne, IN
National Provider Identifier
1710409933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22002084A
- Practice address
- 7902 Crosshill CT
Fort Wayne, IN 46825-3191 - Phone
- (260) 615-3966
- NPI assigned
- Jul 10, 2017
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22002084A | IN | Primary |
Addresses
Primary practice location
7902 Crosshill CT
Fort Wayne, IN 46825-3191
Mailing address
7902 Crosshill CT
Fort Wayne, IN 46825-3191
Phone (260) 615-3966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22002084A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1710409933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7902 CROSSHILL CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468253191",
"telephone_number": "260-615-3966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7902 CROSSHILL CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468253191",
"telephone_number": "260-615-3966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "JACQUELINE",
"credential": "M.ED., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-10",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22002084A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- 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.