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General NPI Number Information
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NPI Number | 1578057774
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Entity Type | Individual
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Provider Name | MAYU KURAMOCHI NASH
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Gender | Female
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2450 44TH ST SE STE 201
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City | KENTWOOD
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State | MI
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Zip | 49512-9081
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Country | US
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Telephone | 616-528-0870
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Fax | 616-591-5684
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Provider Business Mailing Address
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Address Line | 401 HALL ST SW STE 185D
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-6502
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Country | US
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Telephone | 616-300-4432
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Fax | 616-404-3927
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101007492
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License Number State | MI
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