MEDICARE: SUSAN ZIMMERMAN-PHILLIPS M.S. CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	1601000593	MI
2	231HA2400X	Assistive Technology Practitioner Audiologist	1601000593	MI
3	231HA2500X	Assistive Technology Supplier Audiologist	1601000593	MI
4	237600000X	Audiologist-Hearing Aid Fitter	1601000593	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01064854	OTHER	MI	AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE
2	1601000593	OTHER	MI	STATE OF MICHIGAN DEPARTMENT OF LICENSING & REGULATORY AFFAIRS AUDIOLOGY BOARD

General Provider Information

NPI Number	:	1992085286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ZIMMERMAN-PHILLIPS M.S. CCC-A

Provider Business Mailing Address
First Line	:	1320 BROOKLYN AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4415
Country	:	US
Telephone Number	:	313-715-3701
Fax Number	:	734-213-7044

Provider Business Practice Location Address
First Line	:	1320 BROOKLYN AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4415
Country	:	US
Telephone Number	:	313-715-3701
Fax Number	:	734-213-7044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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Directions to “ SUSAN ZIMMERMAN-PHILLIPS M.S. CCC-A” Practice Location

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