Provider Information for 1578605317
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AMY LOUISE BROOKE LCPC
Sex: Female
NPI: 1578605317
Last Updated: 2023-08-07
Certification Date: 2023-08-07
Certification Date: 2023-08-07
Details
| Name | Value | ||||||||
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| NPI | 1578605317 | ||||||||
| Enumeration Date | 2007-02-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 925 E SHELBOURNE DR NORMAL, IL 61761-4923 United States Phone: 309-826-8140 | Fax:309-826-8140 | ||||||||
| Primary Practice Address | 925 E SHELBOURNE DR NORMAL, IL 61761-4923 United States Phone: 309-826-8140 | Fax: | ||||||||
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