Healthcare Provider Details

I. General information

NPI: 1669237889
Provider Name (Legal Business Name): MICHELE FAITH LEWANDOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11208 BALDWIN CIR
HOLLY MI
48442-9381
US

IV. Provider business mailing address

5045 SUMMERFIELD DR
NORTON SHORES MI
49441-6800
US

V. Phone/Fax

Practice location:
  • Phone: 231-736-5098
  • Fax:
Mailing address:
  • Phone: 231-736-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: