Provider Demographics
NPI:1225876949
Name:TODOROSKI, JASON (HIS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TODOROSKI
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26834 LAWRENCE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1262
Mailing Address - Country:US
Mailing Address - Phone:586-600-5907
Mailing Address - Fax:586-759-5778
Practice Address - Street 1:26834 LAWRENCE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1262
Practice Address - Country:US
Practice Address - Phone:586-600-5907
Practice Address - Fax:586-759-5778
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501007969237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist