Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | CC-2C4840199191 | MI |
NPI | 1053066696 |
---|---|
Provider Name | Erin Jungslager |
First Address | Grand Haven, MI 49417-8688 |
Second Address | Grand Haven, MI 49417-8688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2022 |
Last Update Date | 12/02/2022 |