Healthcare Provider Details

I. General information

NPI: 1447378773
Provider Name (Legal Business Name): PERSONALIZED HEARING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35337 WARREN RD
WESTLAND MI
48185-2013
US

IV. Provider business mailing address

35337 WARREN RD
WESTLAND MI
48185-2013
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-5100
  • Fax: 734-467-5103
Mailing address:
  • Phone: 734-467-5100
  • Fax: 734-467-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000113
License Number StateMI

VIII. Authorized Official

Name: DR. KARISSA L JAGACKI
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 734-467-5100