Healthcare Provider Details

I. General information

NPI: 1417123019
Provider Name (Legal Business Name): BRANT AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 COMMONS CIR UNIT C
CHEYENNE WY
82009-2666
US

IV. Provider business mailing address

PO BOX 21804
CHEYENNE WY
82003-7073
US

V. Phone/Fax

Practice location:
  • Phone: 307-426-4327
  • Fax: 307-426-3277
Mailing address:
  • Phone: 307-426-4327
  • Fax: 307-426-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANT R CHRISTENSEN
Title or Position: OWNER
Credential: AU.D.
Phone: 307-426-4327