Individual provider Active NPI

Brooke Amy Cunningham, MA, CCC-SLP

  • Speech-Language Pathologist
  • Parker, CO
National Provider Identifier
1841523008
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
12089448 Issued in CO
Practice address
11479 Pine Dr # 1
Parker, CO 80134-7308
Phone
(303) 840-6374
NPI assigned
Sep 4, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 12089448 CO Primary

Addresses

Primary practice location

11479 Pine Dr # 1
Parker, CO 80134-7308

Mailing address

1187 E Kettle Place
Centennial, CO 80122
Phone (303) 912-2910

Other practice location 1

1350 Josephine St
Unit 505
Denver, CO 80206-2216
Phone (303) 912-2910

Other identifiers 1

IdentifierTypeStateIssuer
53508572MedicaidCO

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 Arts

State licenses

LicenseStateTypeSpecialty
12089448COMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Haaksma Speech Pathology, LLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1841523008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1187 E KETTLE PLACE",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "80122",
            "telephone_number": "303-912-2910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11479 PINE DR # 1",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347308",
            "telephone_number": "303-840-6374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Josephine St",
            "address_2": "Unit 505",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802062216",
            "country_code": "US",
            "telephone_number": "303-912-2910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "BROOKE",
        "middle_name": "AMY",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "12089448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53508572",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parker, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.