Healthcare Provider Details

I. General information

NPI: 1053036681
Provider Name (Legal Business Name): ALLYEHA KRISTINE CHANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 GRAND RIVER RD
BRIGHTON MI
48116-6500
US

IV. Provider business mailing address

20807 KALAMAZOO RD
BIG RAPIDS MI
49307-8837
US

V. Phone/Fax

Practice location:
  • Phone: 800-787-5118
  • Fax:
Mailing address:
  • Phone: 231-912-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: