MEDICARE: LEEANNA CZARNECKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7401003148	MI

General Provider Information

NPI Number	:	1194680751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEANNA CZARNECKI

Provider Business Mailing Address
First Line	:	4035 PIER LIGHT DR APT 304
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49418-9379
Country	:	US
Telephone Number	:	586-925-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 CHICAGO DR SW STE 304
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-260-7915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ LEEANNA CZARNECKI ” Practice Location

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