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General NPI Number Information
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NPI Number | 1861606683
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Entity Type | Individual
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Provider Name | SUSAN LYNNE JONES MILLER MACCCA
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 12725 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1306
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Country | US
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Telephone | 419-873-1783
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Fax | 419-873-8649
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Provider Business Mailing Address
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Address Line | 12725 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1306
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Country | US
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Telephone | 419-873-1783
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Fax | 419-873-8649
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A00661
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License Number State | OH
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