Healthcare Provider Details

I. General information

NPI: 1366872301
Provider Name (Legal Business Name): ANDREW HUNT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19505 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-1643
US

IV. Provider business mailing address

132 E FARNUM AVE
ROYAL OAK MI
48067-1807
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-8200
  • Fax:
Mailing address:
  • Phone: 734-417-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000760
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: