Provider Demographics
NPI:1205685914
Name:MCNABB, CHARLIE DEAN
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:DEAN
Last Name:MCNABB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 GARFIELD RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4016
Mailing Address - Country:US
Mailing Address - Phone:586-333-5405
Mailing Address - Fax:
Practice Address - Street 1:40680 GARFIELD RD STE 1B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4016
Practice Address - Country:US
Practice Address - Phone:586-333-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3502013211231H00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist