Healthcare Provider Details

I. General information

NPI: 1629428669
Provider Name (Legal Business Name): CONNOR HEMPEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 ANN ARBOR RD
JACKSON MI
49201-8801
US

IV. Provider business mailing address

5025 ANN ARBOR RD
JACKSON MI
49201-8801
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-1505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: