Healthcare Provider Details

I. General information

NPI: 1679789804
Provider Name (Legal Business Name): HANNAH KAY ALLEN-MILLER LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 203
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

2020 RAYBROOK ST SE STE 203
GRAND RAPIDS MI
49546-7717
US

V. Phone/Fax

Practice location:
  • Phone: 248-581-8777
  • Fax: 888-975-9374
Mailing address:
  • Phone: 248-581-8777
  • Fax: 888-975-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: