Healthcare Provider Details

I. General information

NPI: 1225311194
Provider Name (Legal Business Name): JARED BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 MINERAL POINT RD STE 15
MADISON WI
53717-1720
US

IV. Provider business mailing address

140 CORPORATE DR STE 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-0075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1322060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: