Provider Demographics
NPI:1184134322
Name:OWENS, BRYAN LEIGHTON
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:LEIGHTON
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E ELM AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2678
Mailing Address - Country:US
Mailing Address - Phone:734-241-4080
Mailing Address - Fax:734-241-4798
Practice Address - Street 1:214 E ELM AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2600
Practice Address - Country:US
Practice Address - Phone:734-241-4080
Practice Address - Fax:734-241-4798
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003274237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty