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General NPI Number Information
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NPI Number | 1942674478
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Entity Type | Organization
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Legal Business Name | SOMMERVILLE AUDIOLOGY, LLC
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 23233 NINE MACK DR
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1969
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Country | US
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Telephone | 586-498-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 23233 NINE MACK DR
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1969
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Country | US
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Telephone | 586-498-5000
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JACLYN SOMMERVILLE
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Credential |
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Telephone | 586-498-5000
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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 | 1601000502
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License Number State | MI
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