Provider Demographics
NPI:1306961651
Name:BREMER, LYNNE MARIE (MA, CCC-A, F-AAA)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:BREMER
Suffix:
Gender:F
Credentials:MA, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ARIZONA STATE SCHOOLS FOR THE DEAF AND THE BLIND
Mailing Address - Street 2:P.O. BOX 88510
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754
Mailing Address - Country:US
Mailing Address - Phone:520-770-3824
Mailing Address - Fax:
Practice Address - Street 1:ARIZONA STATE SCHOOLS FOR THE DEAF AND THE BLIND
Practice Address - Street 2:1200 W SPEEDWAY BLVD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-770-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAUD4203231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933235OtherAHCCCS PIN