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NPI Code Detail

MEDICARE: WENDY FIELDER PHD

MEDICARE:   WENDY  FIELDER  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301005687MI

General Provider Information

NPI Number : 1861465049
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY FIELDER PHD
Provider Business Mailing Address
First Line : 700 3 MILE RD NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49544-8220
Country : US
Telephone Number : 616-942-8060
Fax Number : 616-942-6690
Provider Business Practice Location Address
First Line : 700 3 MILE RD NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49544-8220
Country : US
Telephone Number : 616-942-8060
Fax Number : 616-942-6690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 07/08/2007

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