Healthcare Provider Details

I. General information

NPI: 1144076548
Provider Name (Legal Business Name): ADRIANNA JANE HADDIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HOLLAND LAKE RD
SIDNEY MI
48885-9743
US

IV. Provider business mailing address

770 W HOLLAND LAKE RD
SIDNEY MI
48885-9743
US

V. Phone/Fax

Practice location:
  • Phone: 616-894-3232
  • Fax:
Mailing address:
  • Phone: 616-894-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: