Provider Demographics
NPI:1710125182
Name:FICK, KATHERINE MACKENZIE (AUD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MACKENZIE
Last Name:FICK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:SPEAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0501231H00000X
KY0980237600000X
MI1601001135231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50023223OtherPASSPORT
KY1710125182OtherPASSPORT ADVANTAGE
IN200941130Medicaid
KY0687865Medicare PIN