Provider Demographics
NPI:1013404185
Name:MI-WI SPEECH AND HEARING SERVICES PLLC
Entity Type:Organization
Organization Name:MI-WI SPEECH AND HEARING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-563-7005
Mailing Address - Street 1:415 W US HIGHWAY 2 STE 2
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870-1175
Mailing Address - Country:US
Mailing Address - Phone:906-563-7005
Mailing Address - Fax:906-563-5809
Practice Address - Street 1:415 W US HIGHWAY 2 STE 2
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870
Practice Address - Country:US
Practice Address - Phone:906-563-7005
Practice Address - Fax:906-563-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-15
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000667231H00000X
WI586-156231H00000X
MI7101004159235Z00000X
WI3950-154235Z00000X
MI3501003307237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty