Provider Demographics
NPI:1871624056
Name:BROOCKERD, ELAINE M (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:ELAINE
Middle Name:M
Last Name:BROOCKERD
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4808
Mailing Address - Country:US
Mailing Address - Phone:816-348-1000
Mailing Address - Fax:
Practice Address - Street 1:110 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4808
Practice Address - Country:US
Practice Address - Phone:816-348-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist