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General NPI Number Information
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NPI Number | 1083087175
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Entity Type | Individual
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Provider Name | MONICA ANNE FOUNTAIN AU.D.
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 13565 PORT SHELDON ST
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City | HOLLAND
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State | MI
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Zip | 49424-9241
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Country | US
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Telephone | 616-738-8940
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 BEECHWOOD ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3732
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Country | US
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Telephone | 248-613-4742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1601000718
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License Number State | MI
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