Healthcare Provider Details

I. General information

NPI: 1194382408
Provider Name (Legal Business Name): BRITTNEY ANN DEJOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MANITOU DR NE
GRAND RAPIDS MI
49525-1971
US

IV. Provider business mailing address

2945 MANITOU DR NE
GRAND RAPIDS MI
49525-1971
US

V. Phone/Fax

Practice location:
  • Phone: 616-826-6303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: