Provider Demographics
NPI:1376799569
Name:BREWSTER, KEVIN LYNN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LYNN
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 EASTLAND DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7917
Mailing Address - Country:US
Mailing Address - Phone:309-664-6200
Mailing Address - Fax:
Practice Address - Street 1:2101 EASTLAND DR
Practice Address - Street 2:SUITE E
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7917
Practice Address - Country:US
Practice Address - Phone:309-664-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2564237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist