Provider Demographics
NPI:1821421843
Name:BRAY, SUSAN (AUD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRAY
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 1:5555 GARDEN GROVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8234
Mailing Address - Country:US
Mailing Address - Phone:714-898-5732
Mailing Address - Fax:763-268-4017
Practice Address - Street 1:11550 INDIAN HILLS RD STE 210
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1202
Practice Address - Country:US
Practice Address - Phone:818-837-4327
Practice Address - Fax:818-837-7030
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AU2167237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter