Provider Demographics
NPI:1013897412
Name:BANASZAK, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BANASZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5587
Mailing Address - Country:US
Mailing Address - Phone:989-316-5751
Mailing Address - Fax:
Practice Address - Street 1:715 E MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5488
Practice Address - Country:US
Practice Address - Phone:989-486-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3502013328237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist