Healthcare Provider Details

I. General information

NPI: 1891603924
Provider Name (Legal Business Name): LAURA MAY KALLUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E BELTLINE AVE NE STE C
GRAND RAPIDS MI
49525-9802
US

IV. Provider business mailing address

10303 S NORTH RIVER DR
FREMONT MI
49412-9213
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-4840
  • Fax:
Mailing address:
  • Phone:
  • 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: