Healthcare Provider Details

I. General information

NPI: 1972045466
Provider Name (Legal Business Name): ASHLEY DEMENIUK LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 HANNAN RD
ROMULUS MI
48174-1383
US

IV. Provider business mailing address

600 STEPHENSON HWY
TROY MI
48083-1110
US

V. Phone/Fax

Practice location:
  • Phone: 734-893-1000
  • Fax:
Mailing address:
  • Phone: 248-616-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361004543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: