Healthcare Provider Details

I. General information

NPI: 1861233140
Provider Name (Legal Business Name): HANIGAN A RACELIS MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 DEVELOPMENT DR
LANSING MI
48911-4213
US

IV. Provider business mailing address

204 E CESAR E CHAVEZ AVE APT 10
LANSING MI
48906-4302
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-0421
  • Fax:
Mailing address:
  • Phone: 708-813-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008845
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: