Healthcare Provider Details

I. General information

NPI: 1639721814
Provider Name (Legal Business Name): JESSICA KAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH AVE
BATTLE CREEK MI
49017-3307
US

IV. Provider business mailing address

323 TIMBER RIDGE DR
KALAMAZOO MI
49006-4373
US

V. Phone/Fax

Practice location:
  • Phone: 269-245-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: