Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301010464 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301010464 | MI |
NPI | 1003165770 |
---|---|
Provider Name | Karen Gottschalk |
First Address | Ann Arbor, MI 48104-4532 |
Second Address | Ann Arbor, MI 48104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 30/05/2018 |