Healthcare Provider Details

I. General information

NPI: 1093388043
Provider Name (Legal Business Name): ANISS ELIZABETH LOW HINDMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-3605
US

IV. Provider business mailing address

8781 BAILEY DR NE
ADA MI
49301-9769
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-7300
  • Fax:
Mailing address:
  • Phone: 231-342-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: