Healthcare Provider Details

I. General information

NPI: 1528971389
Provider Name (Legal Business Name): JAMES HUISKENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 ALEXANDRIA LN
DAVISON MI
48423-9021
US

IV. Provider business mailing address

11126 ALEXANDRIA LN
DAVISON MI
48423-9021
US

V. Phone/Fax

Practice location:
  • Phone: 810-397-5956
  • Fax:
Mailing address:
  • Phone: 810-397-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCC-AACKW0143200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: