Individual
MR. JACK DE BOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-A
Contact information
Practice address
2036 CHESANING DR SE, GRAND RAPIDS, MI 49506-5309
(616) 819-3070
(616) 819-3239
Mailing address
2036 CHESANING DR SE, GRAND RAPIDS, MI 49506-5309
(616) 819-3070
(616) 819-3239
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000343
MI
231HA2400X
Assistive Technology Practitioner Audiologist
1601000342
MI
237600000X
Audiologist-Hearing Aid Fitter
1601000343
MI
Other
Enumeration date
11/10/2008
Last updated
11/10/2008
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