Provider Demographics
NPI:1477674919
Name:STACH, BRAD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:STACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:DIVISION OF AUDIOLOGY, K8
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-1089
Mailing Address - Fax:313-916-1548
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:DIVISION OF AUDIOLOGY, K8
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1089
Practice Address - Fax:313-916-1548
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000330231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist