MEDICARE: BROOKE BERNTSON AUD, CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	5657	OK

General Provider Information

NPI Number	:	1376213538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE BERNTSON AUD, CCC-A

Provider Business Mailing Address
First Line	:	6550 E 71ST ST STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-2767
Country	:	US
Telephone Number	:	918-388-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 E 71ST ST STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-2767
Country	:	US
Telephone Number	:	918-388-6644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/17/2021

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