Healthcare Provider Details

I. General information

NPI: 1467602813
Provider Name (Legal Business Name): BROOKLANDS AUDIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 OLD LINCOLN HWY SUITE 103
MALVERN PA
19355-2551
US

IV. Provider business mailing address

9 OLD LINCOLN HWY SUITE 103
MALVERN PA
19355-2551
US

V. Phone/Fax

Practice location:
  • Phone: 610-408-9250
  • Fax:
Mailing address:
  • Phone: 610-408-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAT000887L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAT000887L
License Number StatePA

VIII. Authorized Official

Name: MRS. PATRICIA A. A. COHEN
Title or Position: OWNER
Credential: M.A.,C.C.C.
Phone: 610-408-9250