Provider Demographics
NPI:1578863437
Name:BRUSHETT, STEPHANIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:BRUSHETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8941 ENTRANCE ROAD A
Mailing Address - Street 2:BLDG 3334, RM 125
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8941 ENTRANCE ROAD A
Practice Address - Street 2:BLDG 3334, RM 125
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145
Practice Address - Country:US
Practice Address - Phone:405-582-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8041586-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist