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1164846812
BROOKE DIDOMENICO
CHAMPAIGN, IL
NPI
1164846812
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Former Name
BROOKE BEARDSLEY
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2014-02-14
Last Update Date
2014-02-14
Business Address
-- BROOKE DIDOMENICO
1801 FOX DR
CHAMPAIGN, IL 61820-7236
Phone number: 630-212-8247
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Mailing Address
-- BROOKE DIDOMENICO
414 W ELLS AVE
CHAMPAIGN, IL 61820-6428
Phone number: 630-212-8247
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