Healthcare Provider Details

I. General information

NPI: 1316530728
Provider Name (Legal Business Name): LEEANN MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 W MAIN ST
MILAN MI
48160-1236
US

IV. Provider business mailing address

487 W MAIN ST
MILAN MI
48160-1236
US

V. Phone/Fax

Practice location:
  • Phone: 810-956-6049
  • Fax:
Mailing address:
  • Phone: 810-956-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001514
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: