Provider Demographics
NPI:1164597126
Name:BRAHMER, MELINDA A (CCC-A)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:A
Last Name:BRAHMER
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7463 GRASSY KNOLL TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-8618
Mailing Address - Country:US
Mailing Address - Phone:715-748-2756
Mailing Address - Fax:
Practice Address - Street 1:123 W STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1772
Practice Address - Country:US
Practice Address - Phone:715-748-4447
Practice Address - Fax:715-748-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI288-156237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI51000OtherSECURITY HEALTH PROVIDER
WI41132100Medicaid