Healthcare Provider Details

I. General information

NPI: 1669152625
Provider Name (Legal Business Name): MADYSON SNIECINSKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 BURTON ST SE
GRAND RAPIDS MI
49506-4669
US

IV. Provider business mailing address

1103 E MCDONNELL ST
ESSEXVILLE MI
48732-1217
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-1797
  • Fax:
Mailing address:
  • Phone: 989-415-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: