Basic Information
| Provider Information | |||||||||
| NPI: | 1093892341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GESSNER | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3298 DEPT | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601220021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 KENMOOR AVE SE STE B | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495462391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169541895 | ||||||||
| FaxNumber: | 6169542093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1601000231 | MI | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 64OGO11450 | 01 | MI | BCBSM AUDIOLOGY PROVIDER | OTHER | 1093892341 | 05 | MI | MEDICAID | 54OGO11460 | 01 | MI | BCBSM HEARING AID PROVIDE | OTHER |