Healthcare Provider Details

I. General information

NPI: 1205411402
Provider Name (Legal Business Name): STEPHANIE CUERVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MARKET PL STE A
ANN ARBOR MI
48108-1649
US

IV. Provider business mailing address

475 MARKET PL STE A
ANN ARBOR MI
48108-1649
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-8119
  • Fax: 734-998-8122
Mailing address:
  • Phone: 734-998-8119
  • Fax: 734-998-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008833
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: