Provider Demographics
NPI:1356655773
Name:VESELY, BRIAN (AUD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:VESELY
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 1:820 E MONTCLAIR ST APT 225
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7514
Mailing Address - Country:US
Mailing Address - Phone:501-388-3752
Mailing Address - Fax:
Practice Address - Street 1:3250 E BATTLEFIELD ST STE N
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4081
Practice Address - Country:US
Practice Address - Phone:417-889-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018447231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist