Basic Information
| Provider Information | |||||||||
| NPI: | 1710099759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EIMER | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MA/CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10831 NUGENT AVE NE | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493418683 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3019 COIT AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495053376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163659575 | ||||||||
| FaxNumber: | 6163659564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000069 | MI | X | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 1601000069 | MI | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.