Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301010266 | MI |
Y | 103T00000X | Psychologist | 6301010266 | MI |
NPI | 1003824848 |
---|---|
Provider Name | Megan Auffrey Zambiasi |
First Address | Grand Rapids, MI 49548-6927 |
Second Address | Grand Haven, MI 49417-2480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0894815 | BC/BS (01) | MI |