Healthcare Provider Details

I. General information

NPI: 1407428659
Provider Name (Legal Business Name): ALESSANDRA PUZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

3304 WOODWARD AVE SW
WYOMING MI
49509-3040
US

V. Phone/Fax

Practice location:
  • Phone: 616-382-0531
  • Fax:
Mailing address:
  • Phone: 171-377-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005261
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: