Michelle Jeanine Dennis, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301012904 Issued in MI

Practice address

4127 Embassy Dr SE
Grand Rapids, MI 49546-2418

Phone

(616) 264-3200

NPI assigned

Jun 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2025 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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• Paul Hewitt LLC

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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296691200000",
    "number": "1366486755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 EMBASSY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462418",
            "telephone_number": "616-264-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "MICHELLE",
        "middle_name": "JEANINE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2011-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301012904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "P10D112750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Denney
• Carrie Tenelle Dennie, ND
• Dennis W Nagel DDS PC
• Andrea Nicole Dennis, PT
• Jennifer Lynn Dennis, MA, CCC-SLP
• Mike W Dennis
• Sandra Dennis, MA, LLP
• Melanie Marie Dennison, LMSW
• Sara Jo Denolf, M.D.
• Abigail Denouden

• Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.