Individual
LAUREN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
655 KENMOOR AVE SE, STE A, GRAND RAPIDS, MI 49546-8622
(616) 575-1212
Mailing address
655 KENMOOR AVE SE, STE A, GRAND RAPIDS, MI 49546-8622
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000743
MI
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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