Provider Demographics
NPI:1922429331
Name:COLDREN, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:COLDREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VICTORY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1972
Mailing Address - Country:US
Mailing Address - Phone:816-883-2660
Mailing Address - Fax:816-474-4846
Practice Address - Street 1:3520 W 75TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4102
Practice Address - Country:US
Practice Address - Phone:913-262-4327
Practice Address - Fax:913-262-4330
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1413237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist