Healthcare Provider Details

I. General information

NPI: 1801707971
Provider Name (Legal Business Name): BRADLEY TANGUAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W ELLIS AVE
BELDING MI
48809-1108
US

IV. Provider business mailing address

2191 HARWOOD RD
IONIA MI
48846-9458
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-4100
  • Fax:
Mailing address:
  • Phone: 616-527-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101007584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: