Provider Demographics
NPI:1770139057
Name:PRENTICE, DANA JO
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JO
Last Name:PRENTICE
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 1:12333 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:SAWYER
Mailing Address - State:MI
Mailing Address - Zip Code:49125-9221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 MINERS RD STE C
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9709
Practice Address - Country:US
Practice Address - Phone:269-235-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist