Healthcare Provider Details

I. General information

NPI: 1265083307
Provider Name (Legal Business Name): CLAUDIA VIGNERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67835 GLEASON ST
RICHMOND MI
48062-1361
US

IV. Provider business mailing address

1607 STEIN RD
SAINT CLAIR MI
48079-3011
US

V. Phone/Fax

Practice location:
  • Phone: 810-990-5874
  • Fax:
Mailing address:
  • Phone: 810-990-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: