Basic Information
| Provider Information | |||||||||
| NPI: | 1730340969 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAOLETTI | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | AUD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CUNNINGHAM, WHELAN | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3621 SOUTH STATE STREET | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 475 MARKET PLACE | ||||||||
| Address2: | BLDG 1 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349988119 | ||||||||
| FaxNumber: | 7349988122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000507 | MI | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 1601000507 | MI | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.