Provider Demographics
NPI:1700356417
Name:BRANT AUDIOLOGY, LLC
Entity type:Organization
Organization Name:BRANT AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:307-426-4327
Mailing Address - Street 1:PO BOX 21804
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7073
Mailing Address - Country:US
Mailing Address - Phone:074-264-3273
Mailing Address - Fax:307-426-3277
Practice Address - Street 1:115 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2301
Practice Address - Country:US
Practice Address - Phone:307-235-1901
Practice Address - Fax:307-426-4327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANT AUDIOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY143657100Medicaid