Provider Demographics
NPI:1063561660
Name:DEAF,HEARING, AND SIGN LANGUAGE CENTER INC.
Entity type:Organization
Organization Name:DEAF,HEARING, AND SIGN LANGUAGE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E.D.
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-341-1353
Mailing Address - Street 1:19185 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3219
Mailing Address - Country:US
Mailing Address - Phone:313-341-1353
Mailing Address - Fax:313-341-4091
Practice Address - Street 1:19185 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3219
Practice Address - Country:US
Practice Address - Phone:313-341-1353
Practice Address - Fax:313-341-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002615231H00000X, 237600000X
MI12074769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4747845Medicaid
MI4728607Medicaid