Healthcare Provider Details

I. General information

NPI: 1093705923
Provider Name (Legal Business Name): JOANNE KAREN SCHOUTEN I PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18450 RIVERSIDE DR
BEVERLY HILLS MI
48025-3125
US

IV. Provider business mailing address

18450 RIVERSIDE DR
BEVERLY HILLS MI
48025-3125
US

V. Phone/Fax

Practice location:
  • Phone: 248-563-9825
  • Fax: 248-566-3036
Mailing address:
  • Phone: 248-563-9825
  • Fax: 248-566-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301006461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: