Healthcare Provider Details

I. General information

NPI: 1427965029
Provider Name (Legal Business Name): JENNIFER MICHALAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52585 DEQUINDRE RD
ROCHESTER HILLS MI
48307-2321
US

IV. Provider business mailing address

1158 RIDGEWAY DR
ROCHESTER MI
48307-1771
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-3000
  • Fax:
Mailing address:
  • Phone: 248-219-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001730REN20
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: