Provider Demographics
NPI:1316101223
Name:BUXTON, B. BROOKE (MA, CCC-A)
Entity type:Individual
Prefix:MISS
First Name:B.
Middle Name:BROOKE
Last Name:BUXTON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1900
Mailing Address - Country:US
Mailing Address - Phone:513-932-7816
Mailing Address - Fax:513-932-7938
Practice Address - Street 1:726 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1900
Practice Address - Country:US
Practice Address - Phone:513-932-7816
Practice Address - Fax:513-932-7938
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01496237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0572652Medicaid