Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | MI |
NPI | 1174051692 |
---|---|
Provider Name | Rodney Pallett |
First Address | Comstock Park, MI 49321-9502 |
Second Address | Grand Rapids, MI 49505-5904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2017 |
Last Update Date | 29/05/2017 |