Healthcare Provider Details

I. General information

NPI: 1871898338
Provider Name (Legal Business Name): BEURKENS AUTISM CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 68TH ST SE
CALEDONIA MI
49316-9133
US

IV. Provider business mailing address

3120 68TH ST SE
CALEDONIA MI
49316-9133
US

V. Phone/Fax

Practice location:
  • Phone: 616-698-0306
  • Fax:
Mailing address:
  • Phone: 616-698-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: NICOLE BEURKENS
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 616-698-0306