Provider Demographics
NPI:1538520317
Name:PALICKI, BROOKE MARIE (BA, RN, MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:PALICKI
Suffix:
Gender:F
Credentials:BA, RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8970
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0970
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:419-479-7039
Practice Address - Street 1:3909 WOODLEY RD STE 500
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1179
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:419-479-7039
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.359950163W00000X
OHAPRN.CNP.0029406363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse