Provider Demographics
NPI:1760647564
Name:BRINKMAN, MEGAN (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 44TH ST SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4395
Mailing Address - Country:US
Mailing Address - Phone:616-249-8000
Mailing Address - Fax:
Practice Address - Street 1:1555 44TH ST SW
Practice Address - Street 2:SUITE 200
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4395
Practice Address - Country:US
Practice Address - Phone:616-249-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000338231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist