Provider Demographics
NPI:1174217418
Name:BUITRON COURTER, EMILY GRACE (AUD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:BUITRON COURTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:COURTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 TENEYCK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2493
Mailing Address - Country:US
Mailing Address - Phone:517-205-8940
Mailing Address - Fax:517-205-0108
Practice Address - Street 1:1111 TENEYCK ST STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2493
Practice Address - Country:US
Practice Address - Phone:517-205-8940
Practice Address - Fax:517-205-0108
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001109231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist