Healthcare Provider Details

I. General information

NPI: 1548175656
Provider Name (Legal Business Name): MADISON MARIE HANNAPEL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MICHIGAN AVE STE AND104
YPSILANTI MI
48197-5550
US

IV. Provider business mailing address

3458 ELMWOOD BEACH RD
MIDDLEVILLE MI
49333-8770
US

V. Phone/Fax

Practice location:
  • Phone: 616-648-1110
  • Fax:
Mailing address:
  • Phone: 616-648-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352000990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: