Healthcare Provider Details

I. General information

NPI: 1437984580
Provider Name (Legal Business Name): CLAIRE ANN FELDKAMP BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 CASCADE RD SE STE 3
GRAND RAPIDS MI
49546-8384
US

IV. Provider business mailing address

14880 W EATON HWY
GRAND LEDGE MI
48837-9638
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-4840
  • Fax:
Mailing address:
  • Phone: 517-622-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7402000199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: