Provider Demographics
NPI:1114193471
Name:KROEGER, BRYAN S (HEARING SPECIALIST)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:KROEGER
Suffix:
Gender:M
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6497
Mailing Address - Country:US
Mailing Address - Phone:715-842-9882
Mailing Address - Fax:
Practice Address - Street 1:330 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6497
Practice Address - Country:US
Practice Address - Phone:715-842-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1195-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist