Provider Demographics
NPI:1285837591
Name:GITTERMAN, SUSAN (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GITTERMAN
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2538
Mailing Address - Country:US
Mailing Address - Phone:734-261-8040
Mailing Address - Fax:734-261-8085
Practice Address - Street 1:6255 INKSTER RD.
Practice Address - Street 2:SUITE 202
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2538
Practice Address - Country:US
Practice Address - Phone:734-261-8040
Practice Address - Fax:734-261-8085
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000039237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H20752OtherBLUE CROSS BLUE SHIELD MI