Healthcare Provider Details

I. General information

NPI: 1467627141
Provider Name (Legal Business Name): KODY R. BROOKS AU.D. CCC/A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21216 NORTHWEST FWY STE 310
CYPRESS TX
77429-1439
US

IV. Provider business mailing address

10740 N GESSNER DR STE 310
HOUSTON TX
77064-1240
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-6155
  • Fax: 281-894-2765
Mailing address:
  • Phone: 281-897-0416
  • Fax: 281-890-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80091
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: