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NPI Code Detail

MEDICARE: STACEY HYSELL

MEDICARE: STACEY HYSELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1942173869
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY HYSELL
Provider Business Mailing Address
First Line : 550 MADISON AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-5314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5630 LAKE MICHIGAN DR STE B
Second Line :
City : ALLENDALE
State : MI
Zip : 49401-8115
Country : US
Telephone Number : 616-566-1917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2025
Last Update Date : 09/26/2025

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Directions to “ STACEY HYSELL ” Practice Location

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