Healthcare Provider Details

I. General information

NPI: 1710190244
Provider Name (Legal Business Name): DIANE CAROL ZUCKSCHWERDT MA,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W KING ST STE 301
OWOSSO MI
48867-2117
US

IV. Provider business mailing address

818 W KING ST STE 301
OWOSSO MI
48867-2117
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4800
  • Fax: 989-729-4810
Mailing address:
  • Phone: 989-729-4800
  • Fax: 989-729-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: