Provider Demographics
NPI:1588610653
Name:HAUSBECK-MILLER, KATHLEEN MARY (AUD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:HAUSBECK-MILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:1111 TENEYCK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2461
Practice Address - Country:US
Practice Address - Phone:517-787-1468
Practice Address - Fax:517-787-0613
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4699819Medicaid
MIM25090003Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MI4699819Medicaid