Provider Demographics
NPI:1285789933
Name:GILBERT, JACKIE ANN-MUMMERT (MS)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ANN-MUMMERT
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3619
Mailing Address - Country:US
Mailing Address - Phone:906-225-3161
Mailing Address - Fax:906-225-4621
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 130
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5408
Practice Address - Country:US
Practice Address - Phone:906-225-7660
Practice Address - Fax:906-225-7665
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000071231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E226022642Medicare ID - Type UnspecifiedAUDIOLOGY