Provider Demographics
NPI:1457888109
Name:SOPER, JAMIE BROST (AUD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BROST
Last Name:SOPER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:BROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 WIMBLETON WAY
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2010
Mailing Address - Country:US
Mailing Address - Phone:608-206-6974
Mailing Address - Fax:
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 411
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091933231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist