Healthcare Provider Details

I. General information

NPI: 1184024622
Provider Name (Legal Business Name): BRENDA CLAUSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15440 N 99TH AVE STE 17
SUN CITY AZ
85351-1962
US

IV. Provider business mailing address

215 SHUMAN BLVD STE. 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-0506
  • Fax: 623-974-9901
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: