Healthcare Provider Details

I. General information

NPI: 1376007724
Provider Name (Legal Business Name): HANNAH BRUNNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH HEIDORN

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E CLARK RD STE 360
DEWITT MI
48820-7962
US

IV. Provider business mailing address

1161 E CLARK RD STE 360
DEWITT MI
48820-7962
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: