Healthcare Provider Details

I. General information

NPI: 1710818133
Provider Name (Legal Business Name): CARLEE EMELANDER S EMELANDER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23604 36TH AVE LOT 17
RAVENNA MI
49451-9609
US

IV. Provider business mailing address

23604 36TH AVE LOT 17
RAVENNA MI
49451-9609
US

V. Phone/Fax

Practice location:
  • Phone: 231-769-3950
  • Fax:
Mailing address:
  • Phone: 231-769-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: