Provider Demographics
NPI:1538544101
Name:SUPERIOR OLIVE AUDIOLOGY SERVICES LLC
Entity type:Organization
Organization Name:SUPERIOR OLIVE AUDIOLOGY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:734-398-5724
Mailing Address - Street 1:4195 OLD CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188
Mailing Address - Country:US
Mailing Address - Phone:734-398-5724
Mailing Address - Fax:734-398-5734
Practice Address - Street 1:4195 OLD CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:734-398-5724
Practice Address - Fax:734-398-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000138231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN