Healthcare Provider Details

I. General information

NPI: 1760410294
Provider Name (Legal Business Name): JENNIFER LYNN LYONS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN BLVD CARLS 3RD FLOOR DEPARTMENT OF AUDIOLOGY
DETROIT MI
48201-3704
US

IV. Provider business mailing address

3901 BEAUBIEN BLVD CARLS 3RD FLOOR DEPARTMENT OF AUDIOLOGY
DETROIT MI
48201-3704
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-8903
  • Fax: 313-966-2694
Mailing address:
  • Phone: 313-745-8903
  • Fax: 313-966-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: