Healthcare Provider Details

I. General information

NPI: 1891196374
Provider Name (Legal Business Name): ANITA LEE-BJERKE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 24TH ST
HOLLAND MI
49423-4037
US

IV. Provider business mailing address

251 WASHINGTON BLVD
HOLLAND MI
49423-3234
US

V. Phone/Fax

Practice location:
  • Phone: 616-494-2000
  • Fax:
Mailing address:
  • Phone: 315-404-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: