JEFF E BROCKETT (NPI# 1013931450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013931450 |
| Entity Type | Individual |
| Full Name | JEFF E BROCKETT |
| Credential | ED.D |
| Practice Address |
650 Memorial Dr Bldg 68 Pocatello ID 83209-0001 |
| Mailing Address |
650 Memorial Drive Box 8116 Pocatello ID 83209 |
| Practice Telephone | 2082822556 |
| Mailing Telephone | 2082822556 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-04-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 231H00000X | Audiologist | AUD1233 | ID | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 004413800 | 05 | |
| ID | BLUE CROSS GROUP # AU753 | AU787 | 01 |
| Street Address |
650 MEMORIAL DR BLDG 68 |
| City | POCATELLO |
| State | ID |
| Zip Code | 83209-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093097081 | Eydie Kendall | Physical Therapist | 1400 Terry Drive, Pocatello, ID 83209 | 2011-09-15 |
| 1548548589 | Corrie Elizabeth Holmes | Audiologist | 650 Memorial Drive Building 68, Pocatello, ID 83209 | 2011-07-25 |
| 1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
| 1922204551 | Melody Ann Weaver | Nurse Practitioner | 921 S 8th Ave Stop 8101, Pocatello, ID 83209 | 2007-06-21 |
| 1710482500 | Ashley Letson | Specialist/Technologist | 921 S 8th Ave, Mcintosh Manor D9, Pocatello, ID 83209 | 2018-03-26 |
| 1407261407 | Stephen B Grandy | Dentist | 465 Memorial Drive, Pocatello, ID 83209-0000 | 2014-06-27 |
| 1811595929 | Idaho State University | Counselor | 1400 E Terry Dr Bldg 63, Pocatello, ID 83209-0001 | 2020-10-12 |
| 1174149389 | Santiago A Segura Barron | Specialist/Technologist | Holt Arena 550 Memorial Drive Building 50, Pocatello, ID 83209-0001 | 2020-06-23 |
| 1639658248 | Luis Rodriguez | Psychologist | 1400 Eas Terry Dr Bldg 63 Garrison Hall 5th Floor, Pocatello, ID 83209-0001 | 2018-08-14 |
| 1205384484 | Max Esposito | Physical Medicine & Rehabilitation | 1400 E Terry Dr, Pocatello, ID 83209-0001 | 2016-09-15 |
| Find all providers in zip 83209 | ||||
| Taxonomy Code | 231H00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Audiologist |
| (1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master’s degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy. |
| Notes: Source: (1) American Speech-Language-Hearing Association, (1996, Spring) Scope of practice in Audiology, p. 2 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649712597 | Angie M Mccurdy | Audiologist | 4155 Yellowstone Hwy, Pine Ridge Mall, Pocatello, ID 83202 | 2016-11-09 |
| 1083069488 | Makenzi Gwinn | Audiologist | 777 Hospital Way Ste 115, Pocatello, ID 83201-5175 | 2016-05-04 |
| 1548548589 | Corrie Elizabeth Holmes | Audiologist | 650 Memorial Drive Building 68, Pocatello, ID 83209 | 2011-07-25 |
| 1548563810 | Dawn Marie Young | Audiologist | 305 W Quinn Road, Pocatello, ID 83202 | 2010-12-08 |
| 1881789725 | Mary Josara Wallber | Audiologist | 921 S 8th Ave Stop 8116, Pocatello, ID 83201-5377 | 2006-10-04 |
| 1699869354 | Chris A. Sanford | Audiologist | 921 S 8th Ave, Mail Stop 8116, Pocatello, ID 83209-8116 | 2006-10-03 |
| 1720004419 | Randy Lyman Bishop | Audiologist | 650 Medical Dr, #68, Pocatello, ID 83209-0001 | 2006-07-14 |
| 1487689683 | Jennifer Holst | Audiologist | Idaho State University, 921 S. 8th Stop 8116, Pocatello, ID 83209-0001 | 2006-07-12 |
| 1578508081 | Idaho State University | Audiologist | 650 Memorial Drive, # 68, Pocatello, ID 83209-0001 | 2006-06-18 |
| 1538548839 | Alisa Vineyard | Audiologist | 2350 Via Caporatti Dr, Suite B, Pocatello, ID 83201-5095 | 2015-05-20 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.