Healthcare Provider Details

I. General information

NPI: 1760394654
Provider Name (Legal Business Name): STEPHANIE D'AN DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8533 PARKRIDGE DR
DEXTER MI
48130-9399
US

IV. Provider business mailing address

8533 PARKRIDGE DR
DEXTER MI
48130-9399
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-6620
  • Fax:
Mailing address:
  • Phone: 810-225-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: