Provider Demographics
NPI:1902928864
Name:GROSSE POINTE AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:GROSSE POINTE AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINETTE
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:LEZOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:313-343-5555
Mailing Address - Street 1:20239 MACK AVENUE
Mailing Address - Street 2:GROSSE POINTE AUDIOLOGY
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1769
Mailing Address - Country:US
Mailing Address - Phone:313-343-5555
Mailing Address - Fax:313-343-5304
Practice Address - Street 1:20239 MACK AVENUE
Practice Address - Street 2:GROSSE POINTE AUDIOLOGY
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1769
Practice Address - Country:US
Practice Address - Phone:313-343-5555
Practice Address - Fax:313-343-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI804683505Medicaid
MI904396202Medicaid
MI804683505Medicaid