Basic Information
| Provider Information | |||||||||
| NPI: | 1174103873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZANDERS | ||||||||
| FirstName: | AIJIANA | ||||||||
| MiddleName: | MYETTE CHANELLE | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 RIVER PLACE DR APT 4403 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482075045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204041572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 BEAUBIEN ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137459778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2021 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000860 | MI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.