Healthcare Provider Details

I. General information

NPI: 1063326031
Provider Name (Legal Business Name): LEAH S KUTZLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 HENDERSHOT AVE NW
GRAND RAPIDS MI
49544-9794
US

IV. Provider business mailing address

3950 HENDERSHOT AVE NW
GRAND RAPIDS MI
49544-9794
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-3225
  • Fax:
Mailing address:
  • Phone: 616-304-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: