Healthcare Provider Details

I. General information

NPI: 1568486157
Provider Name (Legal Business Name): JACQUELINE BORLAND AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W 13 MILE RD STE N120
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

16303 ANGORA LN
MACOMB MI
48044-4043
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0141
  • Fax: 248-551-8190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3501003141
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000285
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number160100285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: