Healthcare Provider Details

I. General information

NPI: 1306700760
Provider Name (Legal Business Name): DESTANY JOY DYMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WADSWORTH ST SW
GRAND RAPIDS MI
49548-3131
US

IV. Provider business mailing address

37 WADSWORTH ST SW
GRAND RAPIDS MI
49548-3131
US

V. Phone/Fax

Practice location:
  • Phone: 616-990-4162
  • Fax:
Mailing address:
  • Phone: 616-990-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: