| NPI | 1154583235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI TEN BROEKE Owner 269-372-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801081725) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-06-30 |