Provider Demographics
NPI:1154408557
Name:BRECHEISEN, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:BRECHEISEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S HYDRAULIC ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1908
Mailing Address - Country:US
Mailing Address - Phone:316-269-4327
Mailing Address - Fax:316-262-4327
Practice Address - Street 1:303 S HYDRAULIC ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1908
Practice Address - Country:US
Practice Address - Phone:316-269-4327
Practice Address - Fax:316-262-4327
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCE569237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist