Healthcare Provider Details

I. General information

NPI: 1992388433
Provider Name (Legal Business Name): KIELEE GRINNELL-HOUGHTALING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 LAKESHORE RD
LEXINGTON MI
48450-9719
US

IV. Provider business mailing address

8032 LAKESHORE RD
LEXINGTON MI
48450-9719
US

V. Phone/Fax

Practice location:
  • Phone: 810-201-1783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003239
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: