Provider Demographics
NPI:1689076309
Name:BROOKS, RACHEL (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SW BROADWAY
Mailing Address - Street 2:SUITE #121
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3146
Mailing Address - Country:US
Mailing Address - Phone:503-245-5249
Mailing Address - Fax:
Practice Address - Street 1:2121 SW BROADWAY
Practice Address - Street 2:SUITE #121
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3146
Practice Address - Country:US
Practice Address - Phone:503-245-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist