Healthcare Provider Details

I. General information

NPI: 1912835521
Provider Name (Legal Business Name): EMILY HANLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1643
US

IV. Provider business mailing address

9324 KREUTER RD NE
ROCKFORD MI
49341-9025
US

V. Phone/Fax

Practice location:
  • Phone: 616-889-1404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: