Healthcare Provider Details

I. General information

NPI: 1497820294
Provider Name (Legal Business Name): KERRY KERR MCAVOY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE SUITE D
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

5060 CASCADE RD SE SUITE D
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-2911
  • Fax:
Mailing address:
  • Phone: 616-454-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: