Provider Demographics
NPI:1356016711
Name:KARL, BRENNEN DANIEL (AUD)
Entity Type:Individual
Prefix:
First Name:BRENNEN
Middle Name:DANIEL
Last Name:KARL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3216
Mailing Address - Country:US
Mailing Address - Phone:303-776-8748
Mailing Address - Fax:303-684-9915
Practice Address - Street 1:3439 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2541
Practice Address - Country:US
Practice Address - Phone:303-777-9720
Practice Address - Fax:303-781-9537
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0001100231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist