Provider Demographics
NPI:1174730733
Name:BRUNER-KOBER, KRISTEN MARIE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:BRUNER-KOBER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:KOBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:101 S MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5047
Mailing Address - Country:US
Mailing Address - Phone:918-342-6453
Mailing Address - Fax:918-342-6452
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6453
Practice Address - Fax:918-342-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK253231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8HZN72OtherMEDICARE LODGE GRASS
MT8HZQ54OtherMEDICARE CROW
MT8HZP81OtherMEDICARE PRYOR