Healthcare Provider Details

I. General information

NPI: 1205745650
Provider Name (Legal Business Name): JILL DEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 S UNION ST
GRASS LAKE MI
49240-9023
US

IV. Provider business mailing address

402 S MAIN ST
CHELSEA MI
48118-1271
US

V. Phone/Fax

Practice location:
  • Phone: 517-867-5593
  • Fax:
Mailing address:
  • Phone: 616-893-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: