Provider Demographics
NPI:1598103269
Name:WEAVER, BRANDY KAYE (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:KAYE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:KAYE
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-1824
Mailing Address - Country:US
Mailing Address - Phone:260-306-3444
Mailing Address - Fax:260-306-3777
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1824
Practice Address - Country:US
Practice Address - Phone:260-306-3444
Practice Address - Fax:260-306-3777
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002531A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist