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General NPI Number Information
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NPI Number | 1295072593
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Entity Type | Organization
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Legal Business Name | JEANNE M DUAX PHD PLLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 747 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2046
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Country | US
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Telephone | 248-919-8229
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Fax | 248-319-1192
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Provider Business Mailing Address
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Address Line | 747 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2046
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Country | US
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Telephone | 248-919-8229
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Fax | 248-319-1192
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JEANNE M DUAX
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Credential | PHD
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Telephone | 248-919-8229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014608
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License Number State | MI
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