Individual
BROOKE AMANDA GONTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
628 DRACO DR, PETALUMA, CA 94954-1599
(415) 419-4717
Mailing address
PO BOX 1615, NOVATO, CA 94948-1615
(415) 419-4717
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
26052
CA
Other
Enumeration date
04/03/2020
Last updated
04/03/2020
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