Provider Demographics
NPI:1801685243
Name:BOLDEN, BRIANNE R
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:R
Last Name:BOLDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:RIBECA
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2306 E RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5182
Mailing Address - Country:US
Mailing Address - Phone:847-670-4327
Mailing Address - Fax:
Practice Address - Street 1:2306 E RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5182
Practice Address - Country:US
Practice Address - Phone:847-670-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3551237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist