Provider Demographics
NPI:1629400619
Name:HEROUX, KOLBE (AUD)
Entity Type:Individual
Prefix:
First Name:KOLBE
Middle Name:
Last Name:HEROUX
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4422
Mailing Address - Country:US
Mailing Address - Phone:401-444-5485
Mailing Address - Fax:401-444-6212
Practice Address - Street 1:115 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4422
Practice Address - Country:US
Practice Address - Phone:401-444-5485
Practice Address - Fax:401-444-6212
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00209231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist