Provider Demographics
NPI:1932170511
Name:BROWN, JEAN GOULDER (AUD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:GOULDER
Last Name:BROWN
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 1:84 MA-6A
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-2411
Mailing Address - Country:US
Mailing Address - Phone:508-255-1285
Mailing Address - Fax:508-342-7156
Practice Address - Street 1:84 MA-6A
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2411
Practice Address - Country:US
Practice Address - Phone:508-255-1285
Practice Address - Fax:508-342-7156
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00151231H00000X
MA899231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3627102OtherAETNA
RI409296OtherBLUE CHIP OF RI
RI1594OtherNEIGHBORHOOD HEALTH PLAN
RI27884-5OtherBLUE CROSS BLUE SHIELD
RI45-00043OtherUNITED HEALTH PLAN
RI27884-5OtherBLUE CROSS BLUE SHIELD