Provider Demographics
NPI:1487634945
Name:DOSSIN, JEANETTE LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LYNN
Last Name:DOSSIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:LYNN
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-A
Mailing Address - Street 1:3345 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2328
Mailing Address - Country:US
Mailing Address - Phone:810-252-0339
Mailing Address - Fax:
Practice Address - Street 1:1273 GRATIOT BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2303
Practice Address - Country:US
Practice Address - Phone:810-364-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2018-10-19
Deactivation Date:2018-10-12
Deactivation Code:
Reactivation Date:2018-10-19
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 237600000X
MI1601000060231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640G410840OtherBCBS HEARING EVALUATIONS
MI540G410920OtherBCBS HEARING AID DISPENSI