Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301014008 | MI |
NPI | 1073763710 |
---|---|
Provider Name | Ms. Kylene Lynn Schipper |
First Address | Grand Rapids, MI 49518-0007 |
Second Address | Grand Rapids, MI 49518-0007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 12/05/2015 |