Provider Demographics
NPI:1164762019
Name:WEBB, MICHAEL KENT (AUD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENT
Last Name:WEBB
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1461
Mailing Address - Country:US
Mailing Address - Phone:712-623-4802
Mailing Address - Fax:712-623-9316
Practice Address - Street 1:1010 N BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1461
Practice Address - Country:US
Practice Address - Phone:712-623-4802
Practice Address - Fax:712-623-9316
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075415237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter