Provider Demographics
NPI:1023982964
Name:DUBIE, GWENNYTH MICHELLE
Entity type:Individual
Prefix:
First Name:GWENNYTH
Middle Name:MICHELLE
Last Name:DUBIE
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 1:225 RURAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4126
Mailing Address - Country:US
Mailing Address - Phone:810-432-9274
Mailing Address - Fax:
Practice Address - Street 1:225 RURAL ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4126
Practice Address - Country:US
Practice Address - Phone:810-432-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst