Healthcare Provider Details

I. General information

NPI: 1225967342
Provider Name (Legal Business Name): BRENNA EBBINGHAUS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-7904
US

IV. Provider business mailing address

1603 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-7904
US

V. Phone/Fax

Practice location:
  • Phone: 512-260-2665
  • Fax: 512-260-2668
Mailing address:
  • Phone: 512-260-2665
  • Fax: 512-260-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81890
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number81890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: