Healthcare Provider Details

I. General information

NPI: 1578498986
Provider Name (Legal Business Name): CALLIE BRATTEN-WOERHEIDE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 TANOAK AVE
KALAMAZOO MI
49048-6186
US

IV. Provider business mailing address

6444 TANOAK AVE
KALAMAZOO MI
49048-6186
US

V. Phone/Fax

Practice location:
  • Phone: 314-603-1519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: