Healthcare Provider Details

I. General information

NPI: 1326568601
Provider Name (Legal Business Name): STEPHANIE LYNN VANNATTER MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LYNN WEEKS MA LPC

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 DIXIE HWY
IRA MI
48023-2813
US

IV. Provider business mailing address

9844 DIXIE HWY
IRA MI
48023-2813
US

V. Phone/Fax

Practice location:
  • Phone: 586-716-7600
  • Fax:
Mailing address:
  • Phone: 810-716-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: