Healthcare Provider Details

I. General information

NPI: 1992211387
Provider Name (Legal Business Name): HANNA MICHELLE FIRCHAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STEVENS ST SW
GRAND RAPIDS MI
49507-1526
US

IV. Provider business mailing address

34035 92ND AVE
LAWTON MI
49065-9444
US

V. Phone/Fax

Practice location:
  • Phone: 419-205-0966
  • Fax:
Mailing address:
  • Phone: 419-205-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7402000068
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: