Provider Demographics
NPI:1235541228
Name:MARYROSE HECKSEL, AUD, LLC
Entity Type:Organization
Organization Name:MARYROSE HECKSEL, AUD, LLC
Other - Org Name:AUDIOLOGY & HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARYROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKSEL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:517-321-6801
Mailing Address - Street 1:7201 W SAGINAW HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-321-6801
Mailing Address - Fax:517-321-1737
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:STE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-321-6801
Practice Address - Fax:517-321-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000135237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty