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General NPI Number Information
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NPI Number | 1023714409
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Entity Type | Organization
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Legal Business Name | JACQUELYN KELLOGG, LLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 6018 CORNERSTONE CT SW
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City | GRANDVILLE
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-340-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 6018 CORNERSTONE CT SW
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City | GRANDVILLE
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-340-1061
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JACQUELYN KAY KELLOGG
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Credential | MA, LLP
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Telephone | 616-340-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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