Healthcare Provider Details

I. General information

NPI: 1811076185
Provider Name (Legal Business Name): JENNIFER MCGOWEN AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G4325 MILLER RD
FLINT MI
48507
US

IV. Provider business mailing address

5749 HONERT RD
ORTONVILLE MI
48462-9609
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9180
  • Fax: 810-230-7841
Mailing address:
  • Phone: 248-627-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3501002820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: