Healthcare Provider Details

I. General information

NPI: 1972309995
Provider Name (Legal Business Name): BIANCA LEIGH HAMILTON 3B6878AE-B8D7-44F5-B
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BIANCA LEIGH HAMILTON BIANCA L. HAMILTON

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 W HIGH ST
JACKSON MI
49203
US

IV. Provider business mailing address

163 W HIGH ST
JACKSON MI
49203-3173
US

V. Phone/Fax

Practice location:
  • Phone: 517-240-4590
  • Fax:
Mailing address:
  • Phone: 517-307-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number3936356
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number393657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: