Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301012595 | MI |
Y | 103T00000X | Psychologist | 6301012595 | MI |
NPI | 1003843319 |
---|---|
Provider Name | Michelle Marie Muenzenmeyer |
First Address | Grand Rapids, MI 49548-6927 |
Second Address | Grand Rapids, MI 49525-7044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |