Provider Demographics
NPI:1205043833
Name:BREWSTER VAUDREUIL, BARBARA ANN
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:BREWSTER VAUDREUIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 SUN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2954
Mailing Address - Country:US
Mailing Address - Phone:719-488-1762
Mailing Address - Fax:
Practice Address - Street 1:14860 SUN HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2954
Practice Address - Country:US
Practice Address - Phone:719-488-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0333611231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23156856Medicaid