=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568901940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARED CHARLES OWENS AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2017
-----------------------------------------------------
Last Update Date | 02/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GRANITE POINT DR STE 300
-----------------------------------------------------
City | WYOMISSING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19610-1992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-376-9728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 W 2ND ST
-----------------------------------------------------
City | MOUNT CARMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17851-1209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-854-8584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT006288
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------