Provider Demographics
NPI:1992085286
Name:ZIMMERMAN-PHILLIPS, SUSAN (MS CCC-A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZIMMERMAN-PHILLIPS
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4415
Mailing Address - Country:US
Mailing Address - Phone:313-715-3701
Mailing Address - Fax:734-213-7044
Practice Address - Street 1:1320 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4415
Practice Address - Country:US
Practice Address - Phone:313-715-3701
Practice Address - Fax:734-213-7044
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000593231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01064854OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE
MI1601000593OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING & REGULATORY AFFAIRS AUDIOLOGY BOARD