Healthcare Provider Details

I. General information

NPI: 1447591284
Provider Name (Legal Business Name): PERSONALIZED HEARING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 PETTIBONE ST SUITE 105
SOUTH LYON MI
48178-6000
US

IV. Provider business mailing address

35337 WARREN RD
WESTLAND MI
48185-2013
US

V. Phone/Fax

Practice location:
  • Phone: 248-437-5505
  • Fax: 248-437-5518
Mailing address:
  • Phone: 734-467-5100
  • Fax: 734-467-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARISSA JAGACKI
Title or Position: OWNER
Credential: AUD
Phone: 734-467-5100