Provider Demographics
NPI:1912132820
Name:EDMAN, BRENT (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:EDMAN
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E 200 N
Mailing Address - Street 2:# 105
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4459
Mailing Address - Country:US
Mailing Address - Phone:435-750-5577
Mailing Address - Fax:435-753-7284
Practice Address - Street 1:45 E 200 N
Practice Address - Street 2:# 105
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4459
Practice Address - Country:US
Practice Address - Phone:435-750-5577
Practice Address - Fax:435-753-7284
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT30720824601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist