Provider Demographics
NPI:1962280909
Name:MCINTOSH, JEFFERY PATRICK SCOTT
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:PATRICK SCOTT
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E HOUGHTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1185
Mailing Address - Country:US
Mailing Address - Phone:989-896-0010
Mailing Address - Fax:
Practice Address - Street 1:511 E HOUGHTON AVE STE D
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1185
Practice Address - Country:US
Practice Address - Phone:989-896-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3502013207237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty