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: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11917 WHISPERING OAK LN
SHELBY TOWNSHIP MI
48315-1173
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 350
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 248-274-4622
  • 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: