Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401014746 | MI |
Y | 103TR0400X | Rehabilitation Psychologist | 6301015429 | MI |
NPI | 1447644398 |
---|---|
Provider Name | Katelyn Christina Coddaire |
First Address | Ann Arbor, MI 48104 |
Second Address | Ann Arbor, MI 48104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/03/2015 |