Provider Demographics
NPI:1689974800
Name:PRIM, RACHEL LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:PRIM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1216
Mailing Address - Country:US
Mailing Address - Phone:810-230-9180
Mailing Address - Fax:810-230-7841
Practice Address - Street 1:4325 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1216
Practice Address - Country:US
Practice Address - Phone:810-230-9180
Practice Address - Fax:810-230-7841
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000546237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter