| NPI | 1740997477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA J RUSH Owner 616-780-0590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2023-05-12 |