Provider Demographics
NPI:1346469145
Name:BRUSH, LON (HID)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:
Last Name:BRUSH
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DODGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2019
Mailing Address - Country:US
Mailing Address - Phone:763-441-5073
Mailing Address - Fax:
Practice Address - Street 1:710 DODGE AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2019
Practice Address - Country:US
Practice Address - Phone:763-441-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2310237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist