Provider Demographics
NPI:1821677618
Name:FELDPAUSCH, MARIELE ANN
Entity Type:Individual
Prefix:MISS
First Name:MARIELE
Middle Name:ANN
Last Name:FELDPAUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 W KINLEY RD
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:MI
Mailing Address - Zip Code:48835-9714
Mailing Address - Country:US
Mailing Address - Phone:989-640-8381
Mailing Address - Fax:
Practice Address - Street 1:5250 NORTHLAND DR NE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1096
Practice Address - Country:US
Practice Address - Phone:616-361-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health