Provider Demographics
NPI:1225749757
Name:DAGNALL, CHEYANN DELANEY
Entity Type:Individual
Prefix:MISS
First Name:CHEYANN
Middle Name:DELANEY
Last Name:DAGNALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3320
Mailing Address - Country:US
Mailing Address - Phone:810-434-4118
Mailing Address - Fax:
Practice Address - Street 1:1014 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1513
Practice Address - Country:US
Practice Address - Phone:586-556-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician