Healthcare Provider Details

I. General information

NPI: 1174770051
Provider Name (Legal Business Name): LEA DAWN NORBOTTEN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEA DAWN STACHURSKI MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E STERNBERG RD
MUSKEGON MI
49444-8796
US

IV. Provider business mailing address

1080 E STERNBERG RD
MUSKEGON MI
49444-8796
US

V. Phone/Fax

Practice location:
  • Phone: 231-799-2200
  • Fax: 231-799-2201
Mailing address:
  • Phone: 231-799-2200
  • Fax: 231-799-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12003580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: