Provider Demographics
NPI:1821217597
Name:UNVERSITY OF MICHIGAN HOSPITAL-SPEECH PATHOLOGY
Entity Type:Organization
Organization Name:UNVERSITY OF MICHIGAN HOSPITAL-SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSOC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANNERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-936-7080
Mailing Address - Street 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:1D203UH
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-0999
Mailing Address - Country:US
Mailing Address - Phone:734-936-7080
Mailing Address - Fax:734-615-1532
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:1D203UH
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0999
Practice Address - Country:US
Practice Address - Phone:734-936-7080
Practice Address - Fax:734-615-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38600639261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech