Doctor Name: | DR. DENISE ANN STODDARD |
NPI Number: | 1790095594 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 6301013677 |
Business Practice Address: | 300 W Ferry St Berrien Springs, MI - 491031109 |
Business Phone Number: | 2698155331 |
Business Fax Number: | 2698155061 |
Mailing Address: | 300 W. Ferry Street, BERRIEN SPRINGS |
State: | MI |
Postal Code: | 491031664 |
Phone Number: | 2698155331 |
Fax Number: | 2698155061 |
NPI Enumeration Date: | 10/14/2010 |
NPI Last Update Date: | 12/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 6301013677 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |