Individual
HEATHER JEAN BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC, SLP
Contact information
Practice address
1600 MILLER TRUNK HWY BLDG C, DULUTH, MN 55811-5640
(218) 786-5360
Mailing address
400 EAST THIRD STREET, SSB-5, DULUTH, MN 55805-1951
(218) 786-3146
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7675
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42568100
—
WI
01
—
4600814
MEDICA
—
Enumeration date
06/30/2006
Last updated
12/21/2020
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