Individual
KENNA MARIE BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
612 WOODLAND SQUARE LOOP SE STE 401, LACEY, WA 98503-1070
(360) 999-9053
Mailing address
9611 WASHINGTON BLVD SW, LAKEWOOD, WA 98498-1248
(928) 503-5422
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
CG60792062
WA
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033631668
—
WA
01
—
1780913657
TELECARE MOBILE OUTREACH TEAM
WA
Enumeration date
07/14/2017
Last updated
03/01/2019
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