Basic Information
| Provider Information | |||||||||
| NPI: | 1538520317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALICKI | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | BA, RN, MSN, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8970 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436230970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4194797039 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 WOODLEY RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4194797039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 08/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.359950 | OH | N | Nursing Service Providers | Registered Nurse | 363LP0808X | APRN.CNP.0029406 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.