=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437827607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN RODNEY BRAZEL JR. AU.D., CCC-A
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9600 VETERANS DR SW
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98493-0003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-583-1803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5928 OYSTER BAY RD NW
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98502-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-790-2274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | LD61179763
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------