Provider Demographics
NPI:1154827731
Name:MACHUTA, DAYNA MARIE
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:MARIE
Last Name:MACHUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:MARIE
Other - Last Name:CHOUINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6038 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9676
Mailing Address - Country:US
Mailing Address - Phone:231-632-0080
Mailing Address - Fax:
Practice Address - Street 1:4024 WYATT RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8273
Practice Address - Country:US
Practice Address - Phone:231-632-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011019651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical