Healthcare Provider Details

I. General information

NPI: 1982538427
Provider Name (Legal Business Name): BUSHRA KANAWATI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 E PARIS AVE SE
GRAND RAPIDS MI
49546-2431
US

IV. Provider business mailing address

2151 EASTCASTLE DR SE UNIT 102
GRAND RAPIDS MI
49508-7719
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-7799
  • Fax:
Mailing address:
  • Phone: 714-767-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009476
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: