Provider Demographics
NPI:1770864183
Name:STURLAUGSON, BROCK RONALD (AUD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:RONALD
Last Name:STURLAUGSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8321 SANGRE DE CRISTO RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6425
Mailing Address - Country:US
Mailing Address - Phone:303-984-4414
Mailing Address - Fax:303-984-6244
Practice Address - Street 1:9894 ROSEMONT AVE
Practice Address - Street 2:STE 104
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4102
Practice Address - Country:US
Practice Address - Phone:303-792-9932
Practice Address - Fax:303-792-9936
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO636231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO289632YR4SMedicare PIN