Healthcare Provider Details

I. General information

NPI: 1821253832
Provider Name (Legal Business Name): KEVIN JAY TOLSMA MS, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 07/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6692 SPRING ARBOR RD
JACKSON MI
49201-9322
US

IV. Provider business mailing address

3601 HENDEE RD
JACKSON MI
49201-9836
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-3869
  • Fax:
Mailing address:
  • Phone: 517-841-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: