Sharon L Blackburn, DR. AUDIOLOGY
Individual provider Active NPI Audiologist · Cadillac, MI
NPI 1730154816 · NPPES record last updated Oct 24, 2007
Key facts
- NPI
- 1730154816
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- 00746586 (MI)
- Practice address
- 8872 Professional Dr
Cadillac, MI 49601-8481 - Phone
- (231) 775-9398
- Fax
- (231) 775-9398
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00746586 | MI | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lisa Jacobson D.O., P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 00746586 | MI | Yes |
Addresses
Primary practice location
8872 Professional Dr
Cadillac, MI 49601-8481
Mailing address
8872 Professional Dr
Cadillac, MI 49601-8481
Phone (231) 775-9398
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4674103 | Medicaid | MI |
Other providers in Cadillac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.