Provider Demographics
NPI:1669463113
Name:SASS-SIMON, MARGARET M (MA CCCA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:SASS-SIMON
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 GRAND HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9616
Mailing Address - Country:US
Mailing Address - Phone:231-798-2323
Mailing Address - Fax:231-798-4410
Practice Address - Street 1:6653 GRAND HAVEN RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-9616
Practice Address - Country:US
Practice Address - Phone:231-798-2323
Practice Address - Fax:231-798-4410
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001785237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
640G011250OtherBS HEARING
MI804711136Medicaid
MIP33046FOtherBCN HMO
OP03120Medicare ID - Type Unspecified