Healthcare Provider Details

I. General information

NPI: 1730524661
Provider Name (Legal Business Name): MELISSA ANNE MANNINEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E LANSING DR
EAST LANSING MI
48823-7754
US

IV. Provider business mailing address

8026 LOVEJOY RD
PERRY MI
48872-8903
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-2900
  • Fax:
Mailing address:
  • Phone: 906-231-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401014288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: