Healthcare Provider Details

I. General information

NPI: 1962086843
Provider Name (Legal Business Name): HALEE STALMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 LAKE EASTBROOK BLVD SE STE A
GRAND RAPIDS MI
49546-5931
US

IV. Provider business mailing address

5281 CLYDE PARK AVE SW
WYOMING MI
49509-9506
US

V. Phone/Fax

Practice location:
  • Phone: 489-261-6604
  • Fax:
Mailing address:
  • Phone: 616-719-5462
  • 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: