Healthcare Provider Details

I. General information

NPI: 1114634003
Provider Name (Legal Business Name): MONIZUE DEAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE STANTON

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 W. TEN MILE STE 201
SOUTHFIELD MI
48075
US

IV. Provider business mailing address

26129 GRAND RIVER AVE # 1077
REDFORD MI
48240-1442
US

V. Phone/Fax

Practice location:
  • Phone: 734-215-7421
  • Fax:
Mailing address:
  • Phone: 734-215-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501008117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: