Basic Information
| Provider Information | |||||||||
| NPI: | 1548385438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEARING CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 KENMOOR AVE SE STE B | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495462391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169541895 | ||||||||
| FaxNumber: | 6169542093 | ||||||||
| 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: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LISENBEE | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6169542093 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A.,CCC-A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000191 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.