Healthcare Provider Details

I. General information

NPI: 1891046363
Provider Name (Legal Business Name): JACEY RAENELLE COURSER AUD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WHEELING AVE
CAMBRIDGE OH
43725-2247
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-6647
  • Fax: 740-439-6648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: