Provider Demographics
NPI: | 1386856193 |
---|---|
Name: | SHEVIN-FINCK, EILEEN C (MA CCC-A) |
Entity type: | Individual |
Prefix: | |
First Name: | EILEEN |
Middle Name: | C |
Last Name: | SHEVIN-FINCK |
Suffix: | |
Gender: | F |
Credentials: | MA CCC-A |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 6900 ORCHARD LAKE RD |
Mailing Address - Street 2: | SUITE 314 |
Mailing Address - City: | WEST BLOOMFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48322-3405 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-855-7530 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6900 ORCHARD LAKE RD |
Practice Address - Street 2: | SUITE 314 |
Practice Address - City: | WEST BLOOMFIELD |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48322-3405 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-855-7530 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-05-04 |
Last Update Date: | 2019-03-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 1601000388 | 237700000X, 231H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | |
No | 237700000X | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 3501002322 | Other | HEARING AID-DEALER LICENS |