Provider Demographics
NPI:1134451701
Name:ANDREW, BRANDON DOUGLAS (HIS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DOUGLAS
Last Name:ANDREW
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 W BELL RD
Mailing Address - Street 2:SUITE A-13
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8546
Mailing Address - Country:US
Mailing Address - Phone:623-201-4461
Mailing Address - Fax:
Practice Address - Street 1:7075 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8546
Practice Address - Country:US
Practice Address - Phone:623-201-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4978237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist