Healthcare Provider Details

I. General information

NPI: 1659204725
Provider Name (Legal Business Name): DAKOTA ANN WATTERSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 216
ROCHESTER HILLS MI
48309-1779
US

IV. Provider business mailing address

14844 SHENANDOAH DR
RIVERVIEW MI
48193-7733
US

V. Phone/Fax

Practice location:
  • Phone: 586-202-6458
  • Fax:
Mailing address:
  • Phone: 734-672-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: