Basic Information
| Provider Information | |||||||||
| NPI: | 1932170511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | GOULDER | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 POST RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028867140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019215800 | ||||||||
| FaxNumber: | 4019215826 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 NEEDHAM ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024611615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179646681 | ||||||||
| FaxNumber: | 6176300141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 05/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD00151 | RI | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 3627102 | 01 | AETNA | OTHER | 409296 | 01 | RI | BLUE CHIP OF RI | OTHER | 1594 | 01 | RI | NEIGHBORHOOD HEALTH PLAN | OTHER | 27884-5 | 01 | RI | BLUE CROSS BLUE SHIELD | OTHER | 45-00043 | 01 | RI | UNITED HEALTH PLAN | OTHER |