Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | MI | |
Y | 103T00000X | Psychologist | MI |
NPI | 1013141662 |
---|---|
Provider Name | Terri L Doezema |
First Address | Allegan, MI 49010-9511 |
Second Address | Allegan, MI 49010-9511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 07/02/2013 |