Provider Demographics
NPI:1356976732
Name:GARVEY, JERALYN PATRICE (HIS)
Entity type:Individual
Prefix:
First Name:JERALYN
Middle Name:PATRICE
Last Name:GARVEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1500
Mailing Address - Country:US
Mailing Address - Phone:810-494-1700
Mailing Address - Fax:
Practice Address - Street 1:7200 W SAGINAW HWY STE 3
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1133
Practice Address - Country:US
Practice Address - Phone:517-853-6929
Practice Address - Fax:517-913-1347
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501008286237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist