Provider Demographics
NPI:1497027585
Name:BABER, BRYAN S (BC-HIS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:BABER
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 W HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1824
Mailing Address - Country:US
Mailing Address - Phone:281-667-6545
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD STE F600
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4667
Practice Address - Country:US
Practice Address - Phone:602-863-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE4369237700000X
AZHAD4369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist