Basic Information
| Provider Information | |||||||||
| NPI: | 1285185975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3303 N UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846044438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013737438 | ||||||||
| FaxNumber: | 8013737486 | ||||||||
| Practice Location | |||||||||
| Address1: | 3303 N UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846044438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013737438 | ||||||||
| FaxNumber: | 0137374868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2016032994 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.