Provider Demographics
NPI:1356088801
Name:COMMUNICATION HAVEN, LLC
Entity type:Organization
Organization Name:COMMUNICATION HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEWAAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:269-365-3279
Mailing Address - Street 1:1096 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9305
Mailing Address - Country:US
Mailing Address - Phone:269-365-3279
Mailing Address - Fax:
Practice Address - Street 1:1096 34TH ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9305
Practice Address - Country:US
Practice Address - Phone:269-365-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104474089Medicaid