Healthcare Provider Details

I. General information

NPI: 1821677618
Provider Name (Legal Business Name): MISS MARIELE ANN FELDPAUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 CANAL AVE SW STE 201B
GRANDVILLE MI
49418-2667
US

IV. Provider business mailing address

10650 W KINLEY RD
FOWLER MI
48835-9714
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-6560
  • Fax:
Mailing address:
  • Phone: 989-640-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: