Healthcare Provider Details

I. General information

NPI: 1275845166
Provider Name (Legal Business Name): ANNE CARPENTER PHD, PLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 NILES RD
SAINT JOSEPH MI
49085-8628
US

IV. Provider business mailing address

3408 NILES RD
SAINT JOSEPH MI
49085-8628
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-3324
  • Fax: 269-429-3323
Mailing address:
  • Phone: 269-408-6119
  • Fax: 269-429-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: