Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401007071 | MI |
Y | 103TC1900X | Counseling Psychologist | 6301010873 | MI |
NPI | 1104064740 |
---|---|
Provider Name | Ms. Maria Swiftfoot |
First Address | Kalamazoo, MI 49006-3107 |
Second Address | Kalamazoo, MI 49008-1860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2009 |
Last Update Date | 03/02/2009 |