Healthcare Provider Details

I. General information

NPI: 1902928864
Provider Name (Legal Business Name): GROSSE POINTE AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20239 MACK AVENUE GROSSE POINTE AUDIOLOGY
GROSSE POINTE WOODS MI
48236-1769
US

IV. Provider business mailing address

20239 MACK AVENUE GROSSE POINTE AUDIOLOGY
GROSSE POINTE WOODS MI
48236-1769
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-5555
  • Fax: 313-343-5304
Mailing address:
  • Phone: 313-343-5555
  • Fax: 313-343-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. GINETTE ALICIA LEZOTTE
Title or Position: AUDIOLOGIST/OWNER
Credential: AU.D., CCC-A
Phone: 313-343-5555