Provider Demographics
NPI:1164938536
Name:ROWE, ROBERTA EVE (HAD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:EVE
Last Name:ROWE
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W MCGALLIARD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1702
Mailing Address - Country:US
Mailing Address - Phone:765-287-1245
Mailing Address - Fax:765-288-4574
Practice Address - Street 1:908 W MCGALLIARD RD STE 2
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1702
Practice Address - Country:US
Practice Address - Phone:765-287-1245
Practice Address - Fax:765-288-4574
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001153A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist