Provider Demographics
NPI:1508950106
Name:CROPPER, BRYCE K (AUD)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:K
Last Name:CROPPER
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 1:10 WATERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5488
Mailing Address - Country:US
Mailing Address - Phone:207-892-6280
Mailing Address - Fax:
Practice Address - Street 1:475 PLEASANT ST STE 11
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3951
Practice Address - Country:US
Practice Address - Phone:207-782-1160
Practice Address - Fax:207-783-4284
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1226231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME334530099Medicaid
ME334530099Medicaid
ME03306401Medicare PIN