Provider Demographics
NPI:1649516931
Name:BENNETT, BRIAN J (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-989-9909
Mailing Address - Fax:970-615-7458
Practice Address - Street 1:2731 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-989-9909
Practice Address - Fax:970-615-7458
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000259235500000X, 2355A2700X, 237600000X, 237700000X
CO200588237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000259OtherSTATE LICENSE