Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401015585 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301016727 | MI |
Y | 103G00000X | Clinical Psychologist | 6301016727 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301016727 | MI |
NPI | 1245689348 |
---|---|
Provider Name | Ashley Nederveld |
First Address | Kentwood, MI 49508-6007 |
Second Address | Middleville, MI 49333-9706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 20/03/2017 |