Basic Information
| Provider Information | |||||||||
| NPI: | 1356655773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VESELY | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 E MONTCLAIR ST APT 225 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658077514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013883752 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3250 E BATTLEFIELD ST STE N | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178897500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2010 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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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 | 231H00000X | 2010018447 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.