Provider Demographics
NPI:1902642952
Name:DOURRA, AYETTE (AUD)
Entity type:Individual
Prefix:
First Name:AYETTE
Middle Name:
Last Name:DOURRA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 MACKINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0934
Mailing Address - Country:US
Mailing Address - Phone:810-295-7351
Mailing Address - Fax:
Practice Address - Street 1:2759 MACKINTOSH LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0934
Practice Address - Country:US
Practice Address - Phone:810-295-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist