Provider Demographics
NPI:1700850518
Name:LOWE, RICHARD GREGORY (PHD, AUD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GREGORY
Last Name:LOWE
Suffix:
Gender:M
Credentials:PHD, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 E STATE BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4763
Mailing Address - Country:US
Mailing Address - Phone:260-471-5693
Mailing Address - Fax:260-471-4942
Practice Address - Street 1:3124 E STATE BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4763
Practice Address - Country:US
Practice Address - Phone:260-471-5693
Practice Address - Fax:260-471-4942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001004231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR98418Medicare UPIN
IN667510AMedicare ID - Type Unspecified