Healthcare Provider Details

I. General information

NPI: 1568080844
Provider Name (Legal Business Name): STEPHANIE DUROCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 WHITMORE LAKE RD
BRIGHTON MI
48116-2470
US

IV. Provider business mailing address

32100 TELEGRAPH RD STE 205
BINGHAM FARMS MI
48025-2454
US

V. Phone/Fax

Practice location:
  • Phone: 810-775-3300
  • Fax:
Mailing address:
  • Phone: 248-712-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401002245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: