Provider Demographics
NPI:1316277114
Name:LIVERNOIS, JEANNE ANN (AUD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:LIVERNOIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:ANN
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3352 PADDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1241
Mailing Address - Country:US
Mailing Address - Phone:248-229-3508
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000152231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist