Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301012443 | MI |
N | 103TC0700X | Clinical Psychologist | 6301012443 | MI |
N | 103G00000X | Clinical Psychologist | 6301012443 | MI |
N | 103TC0700X | Clinical Psychologist | 6301012443 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301012443 | MI |
N | 103TF0000X | Family Psychologist | 6301012443 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301012443 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301012443 | MI |
NPI | 1528147360 |
---|---|
Provider Name | Dr. Michael Paul Wolff |
First Address | Byron Center, MI 49315-8547 |
Second Address | Grand Rapids, MI 49525-7053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1528147360 | CLINICAL NEUROPSYCHOLOGIS (01) | MI |