Healthcare Provider Details

I. General information

NPI: 1639851439
Provider Name (Legal Business Name): SHAYLA BARISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 20TH AVE
JENISON MI
49428-8524
US

IV. Provider business mailing address

1939 DIVISION AVE S
GRAND RAPIDS MI
49507-2480
US

V. Phone/Fax

Practice location:
  • Phone: 616-327-6153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: