Provider Demographics
NPI:1548404379
Name:BRORSON, KENT ROBERT (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ROBERT
Last Name:BRORSON
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N 43RD AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1480
Mailing Address - Country:US
Mailing Address - Phone:218-525-6075
Mailing Address - Fax:
Practice Address - Street 1:1701 N 43RD AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-1480
Practice Address - Country:US
Practice Address - Phone:218-525-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist