Healthcare Provider Details

I. General information

NPI: 1740240704
Provider Name (Legal Business Name): JUDITH K KUIPER PHD LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 LEONARD NE
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

PO BOX 30516 DEPT 6001A
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-1122
  • Fax: 616-956-8033
Mailing address:
  • Phone: 616-235-2090
  • Fax: 616-235-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: