Healthcare Provider Details

I. General information

NPI: 1225306798
Provider Name (Legal Business Name): PAULA STANIFER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 LAPLAISANCE RD #123
MONROE MI
48161
US

IV. Provider business mailing address

730 N MACOMB ST STE 200
MONROE MI
48162-2904
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-3850
  • Fax:
Mailing address:
  • Phone: 734-240-1760
  • Fax: 734-240-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401012047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: