Provider Demographics
NPI:1366970634
Name:BROWN, KYLE (AUD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 ROAD 15
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9465
Mailing Address - Country:US
Mailing Address - Phone:419-969-9206
Mailing Address - Fax:
Practice Address - Street 1:705 OAK ST UNIT 1
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:616-954-1895
Practice Address - Fax:231-592-4436
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1962757583231H00000X
OH02071231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist