| NPI | 1245372150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 103G00000X Clinical Neuropsychologist | |
| 104100000X Social Worker | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-11-04 |