Provider Demographics
NPI:1235615345
Name:GRIFFITH, BRETT JERROD (HAS)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JERROD
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2648
Mailing Address - Country:US
Mailing Address - Phone:937-629-9191
Mailing Address - Fax:937-390-9193
Practice Address - Street 1:1922 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2648
Practice Address - Country:US
Practice Address - Phone:937-629-9191
Practice Address - Fax:937-390-9193
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2937237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205967304OtherBELTONE HEARING CARE CENTER