Healthcare Provider Details

I. General information

NPI: 1629904263
Provider Name (Legal Business Name): ANNETTA MEILLEUR MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11950 RILEY ST
HOLLAND MI
49424-8553
US

IV. Provider business mailing address

10907 BREES WAY
HOLLAND MI
49423-9233
US

V. Phone/Fax

Practice location:
  • Phone: 616-786-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: