Healthcare Provider Details

I. General information

NPI: 1245079623
Provider Name (Legal Business Name): DENISE POLCE LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 HURON RIVER DR
NEW BOSTON MI
48164-9272
US

IV. Provider business mailing address

1 HERITAGE DR STE 261
SOUTHGATE MI
48195-2574
US

V. Phone/Fax

Practice location:
  • Phone: 734-546-8594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: