Healthcare Provider Details

I. General information

NPI: 1588396725
Provider Name (Legal Business Name): BREANNE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 NORTH LOOP W STE 620
HOUSTON TX
77008-1536
US

IV. Provider business mailing address

6400 FANNIN ST STE 2700
HOUSTON TX
77030-1539
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-2090
  • Fax: 713-868-7046
Mailing address:
  • Phone: 713-486-5000
  • Fax: 713-383-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81403
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: