Individual
BETHANIE BLACKANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(616) 942-2810
Mailing address
1277 COBB DR SE APT 3A, GRAND RAPIDS, MI 49508-7164
(313) 670-2065
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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