Provider Demographics
NPI:1750482840
Name:CONSTANCE BROWN HEARING AND SPEECH CENTER
Entity Type:Organization
Organization Name:CONSTANCE BROWN HEARING AND SPEECH CENTER
Other - Org Name:CONSTANCE BROWN HEARING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-2601
Mailing Address - Street 1:1634 GULL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1632
Mailing Address - Country:US
Mailing Address - Phone:269-343-2601
Mailing Address - Fax:
Practice Address - Street 1:1634 GULL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1632
Practice Address - Country:US
Practice Address - Phone:269-343-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON48560Medicare ID - Type Unspecified