Great Lakes Provider Network, LLC

Primary specialty

AudiologistTaxonomy code 231H00000X

Legal business name

GREAT LAKES PROVIDER NETWORK, LLC

Practice address

33900 Harper Ave Ste A101
Clinton Township, MI 48035-4258

Phone

(586) 359-2649

Fax

(844) 522-5038

NPI assigned

Mar 7, 2017

Last updated

Mar 7, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

AUDIONET AMERICA HOLDINGS INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Colleen Shefferly

Title

President

Phone

(586) 944-0043

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1649710823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE A101",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-359-2649",
            "fax_number": "844-522-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE A101",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-359-2649",
            "fax_number": "844-522-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PROVIDER NETWORK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AUDIONET AMERICA HOLDINGS INC",
        "enumeration_date": "2017-03-07",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "SHEFFERLY",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-944-0043",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Audiologist in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Audiologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.