Individual
KELLY LYONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
961 4 MILE RD NW, GRAND RAPIDS, MI 49544-8252
(616) 784-6299
Mailing address
961 4 MILE RD NW, GRAND RAPIDS, MI 49544-8252
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000745
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1601000745
—
MI
Enumeration date
09/08/2016
Last updated
09/08/2016
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