Healthcare Provider Details

I. General information

NPI: 1497659437
Provider Name (Legal Business Name): BREE BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 PORTAGE RD STE B
PORTAGE MI
49002-1774
US

IV. Provider business mailing address

1119 CHERRY ST
KALAMAZOO MI
49008-1878
US

V. Phone/Fax

Practice location:
  • Phone: 269-888-3839
  • Fax:
Mailing address:
  • Phone: 269-615-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451025340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: