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General NPI Number Information
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NPI Number | 1194680751
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Entity Type | Individual
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Provider Name | LEEANNA CZARNECKI
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 4370 CHICAGO DR SW STE 304
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City | GRANDVILLE
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State | MI
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Zip | 49418-1694
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Country | US
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Telephone | 616-260-7915
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Fax |
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Provider Business Mailing Address
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Address Line | 4035 PIER LIGHT DR APT 304
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City | WYOMING
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State | MI
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Zip | 49418-9379
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Country | US
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Telephone | 586-925-1900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401003148
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License Number State | MI
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