Provider Demographics
NPI:1568490142
Name:BARTEL, JEREMY MICHAEL (MS, CCC-A, CNIM)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:BARTEL
Suffix:
Gender:M
Credentials:MS, CCC-A, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 ROCKHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7735
Mailing Address - Country:US
Mailing Address - Phone:805-558-2446
Mailing Address - Fax:
Practice Address - Street 1:3420 ROCKHAMPTON DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93012-7735
Practice Address - Country:US
Practice Address - Phone:805-558-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2179231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAU2179BMedicare ID - Type UnspecifiedAUDIOLOGY