Individual
MICHELLE JEANINE DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4127 EMBASSY DR SE, GRAND RAPIDS, MI 49546-2418
(616) 264-3200
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301012904
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P10D112750
BC/BS
MI
Enumeration date
06/15/2006
Last updated
02/03/2011
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