Healthcare Provider Details

I. General information

NPI: 1841727732
Provider Name (Legal Business Name): MICHELLE LYNEA DODGE MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N STATE RD
IONIA MI
48846-9687
US

IV. Provider business mailing address

3550 N STATE RD
IONIA MI
48846-9687
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-0571
  • Fax:
Mailing address:
  • Phone: 616-443-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008864
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14102758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: