Healthcare Provider Details

I. General information

NPI: 1992085286
Provider Name (Legal Business Name): SUSAN ZIMMERMAN-PHILLIPS M.S. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BROOKLYN AVE
ANN ARBOR MI
48104-4415
US

IV. Provider business mailing address

1320 BROOKLYN AVE
ANN ARBOR MI
48104-4415
US

V. Phone/Fax

Practice location:
  • Phone: 313-715-3701
  • Fax: 734-213-7044
Mailing address:
  • Phone: 313-715-3701
  • Fax: 734-213-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000593
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number1601000593
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number1601000593
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: