Organization
PERSONALIZED HEARING CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARISSA JAGACKI AUD (OWNER)
(734) 467-5100
Entity
Organization
Contact information
Practice address
321 PETTIBONE ST, SUITE 105, SOUTH LYON, MI 48178-6000
(248) 437-5505
(248) 437-5518
Mailing address
35337 WARREN RD, WESTLAND, MI 48185-2013
(734) 467-5100
(734) 467-5103
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H10426
BLUE CROSS BLUE SHIELD
MI
05
—
4433772
—
MI
Enumeration date
03/04/2013
Last updated
03/04/2013
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