Provider Demographics
NPI:1548378839
Name:TEDESCO, JONI LYNNE (MA AUDIOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:LYNNE
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:MA AUDIOLOGY
Other - Prefix:
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Mailing Address - Street 1:33047 MYRNA CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2915
Mailing Address - Country:US
Mailing Address - Phone:734-522-6972
Mailing Address - Fax:734-838-9991
Practice Address - Street 1:36111 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1400
Practice Address - Country:US
Practice Address - Phone:734-838-9990
Practice Address - Fax:734-838-9991
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1601000020231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4391369Medicaid
MI4391369Medicaid