Healthcare Provider Details

I. General information

NPI: 1326558735
Provider Name (Legal Business Name): HEATHER HESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 04/06/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 HAMPTON LN NW APT 1B
GRAND RAPIDS MI
49534-7816
US

IV. Provider business mailing address

533 HAMPTON LN NW APT 1B
GRAND RAPIDS MI
49534-7816
US

V. Phone/Fax

Practice location:
  • Phone: 734-604-5881
  • Fax:
Mailing address:
  • Phone: 734-604-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-27937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: