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General NPI Number Information
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NPI Number | 1013897412
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Entity Type | Individual
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Provider Name | JODI BANASZAK
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Gender | Female
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 715 E MAIN ST STE 115
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City | MIDLAND
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State | MI
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Zip | 48640-5488
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Country | US
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Telephone | 989-486-1457
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Fax |
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Provider Business Mailing Address
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Address Line | 728 AVONDALE ST
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City | BAY CITY
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State | MI
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Zip | 48708-5587
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Country | US
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Telephone | 989-316-5751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3502013328
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License Number State | MI
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