Provider Demographics
NPI:1760410294
Name:LYONS, JENNIFER LYNN (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:LYONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN BLVD
Mailing Address - Street 2:CARLS 3RD FLOOR DEPARTMENT OF AUDIOLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-3704
Mailing Address - Country:US
Mailing Address - Phone:313-745-8903
Mailing Address - Fax:313-966-2694
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:CARLS 3RD FLOOR DEPARTMENT OF AUDIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3704
Practice Address - Country:US
Practice Address - Phone:313-745-8903
Practice Address - Fax:313-966-2694
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
231H00000X
MI1601000073231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist