Healthcare Provider Details

I. General information

NPI: 1982509238
Provider Name (Legal Business Name): ANNIKA GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10160 96TH AVE
ALLENDALE MI
49401-7574
US

IV. Provider business mailing address

2125 LAWNEL AVE
NORTON SHORES MI
49441-3647
US

V. Phone/Fax

Practice location:
  • Phone: 616-834-3666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: