MEDICARE: MIKAELA RENEE ADKINS

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	7401003137	MI

General Provider Information

NPI Number	:	1962141697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA RENEE ADKINS

Provider Business Mailing Address
First Line	:	854 WASHINGTON AVE STE 600
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2177
Country	:	US
Telephone Number	:	616-344-4508
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	12/15/2025

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