Healthcare Provider Details

I. General information

NPI: 1669595823
Provider Name (Legal Business Name): LYNN STEPHEN ALVORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD K-8, DIVISION OF AUDIOLOGY
DETROIT MI
48202-2608
US

IV. Provider business mailing address

10588 S REDWOOD RD STE B
SOUTH JORDAN UT
84095-8503
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-9129
  • Fax:
Mailing address:
  • Phone: 586-323-2944
  • Fax: 313-916-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501004519
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000078
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000078
License Number State
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number104292-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: