Basic Information
| Provider Information | |||||||||
| NPI: | 1033510821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEARBORN SPEECH AND SENSORY CENTER, INC | ||||||||
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| OtherOrganizationName: | DEARBORN SPEECH, SENSORY & ABA CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23936 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137321461 | ||||||||
| FaxNumber: | 3133471652 | ||||||||
| Practice Location | |||||||||
| Address1: | 23936 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132784601 | ||||||||
| FaxNumber: | 3133471652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHAFFER | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATH/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3137321461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | 7101002229 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.