Healthcare Provider Details

I. General information

NPI: 1457732190
Provider Name (Legal Business Name): MS. AUNDREYA BROOKE EYMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 3RD ST
BORGER TX
79007-4008
US

IV. Provider business mailing address

600 W 3RD ST
BORGER TX
79007-4008
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-9856
  • Fax: 806-274-9859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number34266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: