Healthcare Provider Details

I. General information

NPI: 1033013677
Provider Name (Legal Business Name): BRENDA LEE NEAL HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W PARK DR STE 111
GRAND JUNCTION CO
81505-1454
US

IV. Provider business mailing address

120 W PARK DR STE 111
GRAND JUNCTION CO
81505-1454
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-1111
  • Fax: 970-242-1111
Mailing address:
  • Phone: 970-242-1111
  • Fax: 970-242-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberHAD.0000628
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: