Healthcare Provider Details

I. General information

NPI: 1730801846
Provider Name (Legal Business Name): AMBER ANN SIMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 CASCADE RD SE
GRAND RAPIDS MI
49546-8384
US

IV. Provider business mailing address

4234 CASCADE RD SE
GRAND RAPIDS MI
49546-8384
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-4840
  • Fax: 888-371-9170
Mailing address:
  • Phone: 616-202-4840
  • Fax: 888-371-9170

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: