Individual
JANICE LYNN BROCKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
605 E PROMENADE ST, MEXICO, MO 65265-2926
(573) 581-1332
(573) 581-6652
Mailing address
605 E PROMENADE ST, P.O. BOX 957, MEXICO, MO 65265-2926
(573) 581-1332
(573) 581-6652
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
105762
MO
Other
Enumeration date
11/09/2005
Last updated
07/08/2007
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