| NPI | 1063701175 |
|---|---|
| Former Name | KELLY JO VAN VALKENBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301011390) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |