Healthcare Provider Details

I. General information

NPI: 1831158898
Provider Name (Legal Business Name): HEATHER A. KIRKPATRICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6379 SILVER LAKE RD
LINDEN MI
48451-8706
US

IV. Provider business mailing address

6379 SILVER LAKE RD
LINDEN MI
48451-8706
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-4727
  • Fax: 810-762-4526
Mailing address:
  • Phone: 810-762-4727
  • Fax: 810-762-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301011121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: