Healthcare Provider Details

I. General information

NPI: 1972302172
Provider Name (Legal Business Name): ANNA STORNANT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 320
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

800 MONROE AVE NW STE 320
GRAND RAPIDS MI
49503-1451
US

V. Phone/Fax

Practice location:
  • Phone: 616-558-6295
  • Fax:
Mailing address:
  • Phone: 616-558-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451014379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: