Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301006290 | MI |
Y | 103T00000X | Psychologist | 6301006290 | MI |
NPI | 1003989286 |
---|---|
Provider Name | Ms. Kathleen Weeks Mielke |
First Address | Troy, MI 48085-1277 |
Second Address | Troy, MI 48085-1277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |