Healthcare Provider Details

I. General information

NPI: 1538502000
Provider Name (Legal Business Name): HEIDI CARLSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI SINER

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 GEZON PKWY SW
WYOMING MI
49509-9542
US

IV. Provider business mailing address

4152 CHAMINADE DR SW
GRANDVILLE MI
49418-2589
US

V. Phone/Fax

Practice location:
  • Phone: 616-773-2908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01029214
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: