Provider Demographics
NPI:1891944245
Name:BARAK, SEAN ADAM (AUD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ADAM
Last Name:BARAK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 DRY CREEK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7732
Mailing Address - Country:US
Mailing Address - Phone:720-494-9111
Mailing Address - Fax:720-494-9555
Practice Address - Street 1:1325 DRY CREEK DR STE 103
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7732
Practice Address - Country:US
Practice Address - Phone:720-494-9111
Practice Address - Fax:720-494-9555
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000527231H00000X
GAAUD003813231H00000X
COAUD.0000848237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I644705Medicare PIN