Provider Demographics
NPI:1245310911
Name:ROWE, JEFF R (HAD)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:R
Last Name:ROWE
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:908 W MCGALLIARD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303
Mailing Address - Country:US
Mailing Address - Phone:765-287-1245
Mailing Address - Fax:765-288-4574
Practice Address - Street 1:900 W MCGALLIARD RD
Practice Address - Street 2:SUITE B
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?:Yes
Enumeration Date:2006-10-17
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001152A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484570AMedicaid