Basic Information
Provider Information | |||||||||
NPI: | 1144278680 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEATON | ||||||||
FirstName: | SHELLY | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AUD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BENNETT | ||||||||
OtherFirstName: | SHELLY | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1600 COMMERCE PARK DR STE 300 | ||||||||
Address2: |   | ||||||||
City: | CHELSEA | ||||||||
State: | MI | ||||||||
PostalCode: | 481181620 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7344330699 | ||||||||
FaxNumber: | 7344331307 | ||||||||
Practice Location | |||||||||
Address1: | 1600 COMMERCE PARK DR STE 300 | ||||||||
Address2: |   | ||||||||
City: | CHELSEA | ||||||||
State: | MI | ||||||||
PostalCode: | 48118 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7344330699 | ||||||||
FaxNumber: | 7344331307 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2006 | ||||||||
LastUpdateDate: | 09/20/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000303 | MI | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.