Healthcare Provider Details

I. General information

NPI: 1558275404
Provider Name (Legal Business Name): ALYSON JAYNE LONSWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6963 W KL AVE STE B
KALAMAZOO MI
49009-8043
US

IV. Provider business mailing address

455 DILLINGHAM LN
KALAMAZOO MI
49009-2441
US

V. Phone/Fax

Practice location:
  • Phone: 269-544-7720
  • Fax:
Mailing address:
  • Phone: 269-806-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451024890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: