Healthcare Provider Details

I. General information

NPI: 1457805616
Provider Name (Legal Business Name): AUDREY AUKEMAN MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

IV. Provider business mailing address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-6514
  • Fax:
Mailing address:
  • Phone: 616-202-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: