Healthcare Provider Details

I. General information

NPI: 1629400619
Provider Name (Legal Business Name): KOLBE HEROUX AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GEORGIA AVE
PROVIDENCE RI
02905-4422
US

IV. Provider business mailing address

115 GEORGIA AVE
PROVIDENCE RI
02905-4422
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5485
  • Fax: 401-444-6212
Mailing address:
  • Phone: 401-444-5485
  • Fax: 401-444-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00209
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: