Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1427576263 |
---|---|
Provider Name | Diana Lynn Springstead |
First Address | Muskegon, MI 49443 |
Second Address | Muskegon, MI 49442-3322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2017 |
Last Update Date | 28/12/2017 |