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General NPI Number Information
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NPI Number | 1417801424
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Entity Type | Organization
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Legal Business Name | THE HAIR EXTENSIONIST
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 216 N 3RD ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1212
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Country | US
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Telephone | 616-215-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 WOODRIDGE ST
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City | MUSKEGON
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State | MI
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Zip | 49442-4930
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Country | US
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Telephone | 616-215-2133
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Fax | 616-215-2133
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS PRACTITIONER
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Name | ASHLEY GOLDSBOROUGH
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Credential | CERTIFICATION - USTI
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Telephone | 616-215-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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