Healthcare Provider Details

I. General information

NPI: 1508224023
Provider Name (Legal Business Name): MICHELLE DUNN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W BULLARD AVE STE A4
CLOVIS CA
93612-0857
US

IV. Provider business mailing address

200 W BULLARD AVE STE A4
CLOVIS CA
93612-0857
US

V. Phone/Fax

Practice location:
  • Phone: 559-574-3002
  • Fax: 559-701-0332
Mailing address:
  • Phone: 559-574-3002
  • Fax: 559-701-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number32357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: