Individual
MRS. MARY DISSELKOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1353 VAN AUKEN ST SE, GRAND RAPIDS, MI 49508-2516
(616) 819-2685
(616) 819-2684
Mailing address
1353 VAN AUKEN ST SE, GRAND RAPIDS, MI 49508-2516
(616) 819-2685
(616) 819-2684
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000230
MI
231HA2400X
Assistive Technology Practitioner Audiologist
1601000230
MI
237600000X
Audiologist-Hearing Aid Fitter
1601000230
MI
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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