Healthcare Provider Details

I. General information

NPI: 1760135743
Provider Name (Legal Business Name): KATHRYN WARREN,MA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

2020 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7717
US

V. Phone/Fax

Practice location:
  • Phone: 616-649-1010
  • Fax: 616-551-2895
Mailing address:
  • Phone: 616-649-1010
  • Fax: 616-551-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN L WARREN
Title or Position: OWNER
Credential: MA LLP
Phone: 616-828-6827