Basic Information
| Provider Information | |||||||||
| NPI: | 1487906681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUETTEL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD | ||||||||
| Address2: | SUITE 300-N | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036595115 | ||||||||
| FaxNumber: | 5036595968 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 S POWER RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852065295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803259097 | ||||||||
| FaxNumber: | 4809247930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 10/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAD5865 | AZ | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.