Provider Demographics
NPI:1730239005
Name:REED, NANCY L (MA, CCCA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:MA, CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1455
Mailing Address - Fax:906-483-1457
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1455
Practice Address - Fax:906-483-1457
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000364231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C16002OtherMEDICARE GROUP
MI540C102750OtherBCBS HEARING AID
MI640C126000OtherBCBS HEARING SERVICES
MI904340913Medicaid
MI0829560001OtherMEDICARE DME
MINR000364OtherBLUE CROSS
MI905257894Medicaid