Basic Information
| Provider Information | |||||||||
| NPI: | 1366970634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | KYLE | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2168 ROAD 15 | ||||||||
| Address2: | |||||||||
| City: | LEIPSIC | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458569465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199699206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 705 OAK ST UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169541895 | ||||||||
| FaxNumber: | 2315924436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 02071 | OH | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.