Provider Demographics
NPI:1447591284
Name:PERSONALIZED HEARING CARE
Entity Type:Organization
Organization Name:PERSONALIZED HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGACKI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:734-467-5100
Mailing Address - Street 1:35337 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2013
Mailing Address - Country:US
Mailing Address - Phone:734-467-5100
Mailing Address - Fax:734-467-5103
Practice Address - Street 1:321 PETTIBONE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-6000
Practice Address - Country:US
Practice Address - Phone:248-437-5505
Practice Address - Fax:248-437-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H10426OtherBLUE CROSS BLUE SHIELD
MI4433772Medicaid
MI4433772Medicaid