Provider Demographics
NPI:1437938719
Name:BERNARD, FALLON BROOKE
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:BROOKE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SHENANDOAH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1042
Mailing Address - Country:US
Mailing Address - Phone:713-523-3633
Mailing Address - Fax:713-523-8399
Practice Address - Street 1:3100 SHENANDOAH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1042
Practice Address - Country:US
Practice Address - Phone:713-523-3633
Practice Address - Fax:713-523-8399
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81676231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist