Provider Demographics
NPI:1124222518
Name:BRIGGS, MARY THERESA
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:THERESA
Other - Last Name:GRATZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17894 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6250
Mailing Address - Country:US
Mailing Address - Phone:313-886-6903
Mailing Address - Fax:313-886-7902
Practice Address - Street 1:17894 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6250
Practice Address - Country:US
Practice Address - Phone:313-886-6903
Practice Address - Fax:313-886-7902
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000298231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist