Provider Demographics
NPI:1093892341
Name:GESSNER, BARBARA JOY (AUD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOY
Last Name:GESSNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:751 KENMOOR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2391
Practice Address - Country:US
Practice Address - Phone:616-954-1895
Practice Address - Fax:616-954-2093
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000231237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI64OGO11450OtherBCBSM AUDIOLOGY PROVIDER
MI1093892341Medicaid
MI54OGO11460OtherBCBSM HEARING AID PROVIDE