Healthcare Provider Details

I. General information

NPI: 1285043760
Provider Name (Legal Business Name): CENTRAL MICHIGAN UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HEALTH PROFESSIONS BLDG
MT PLEASANT MI
48859-0001
US

IV. Provider business mailing address

1101 HEALTH PROFESSIONS BLDG
MT PLEASANT MI
48859-0001
US

V. Phone/Fax

Practice location:
  • Phone: 989-774-3904
  • Fax: 989-774-1891
Mailing address:
  • Phone: 989-774-3904
  • Fax: 989-774-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KATE R HODGKINS
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 989-774-6624