Healthcare Provider Details

I. General information

NPI: 1194680751
Provider Name (Legal Business Name): LEEANNA CZARNECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 CHICAGO DR SW STE 304
GRANDVILLE MI
49418-1694
US

IV. Provider business mailing address

4035 PIER LIGHT DR APT 304
WYOMING MI
49418-9379
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-7915
  • Fax:
Mailing address:
  • Phone: 586-925-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: