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General NPI Number Information
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NPI Number | 1194088377
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Entity Type | Organization
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Legal Business Name | KJC323PLLC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 967 SPAULDING AVE SE SUITE E
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City | ADA
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State | MI
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Zip | 49301-3700
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Country | US
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Telephone | 616-464-4324
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Fax | 616-949-5336
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Provider Business Mailing Address
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Address Line | 967 SPAULDING AVE SE SUITE E
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City | ADA
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State | MI
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Zip | 49301-3700
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Country | US
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Telephone | 616-464-4324
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Fax | 616-949-5336
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATHLEEN JANDERNOA CRAMER
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Credential | PHD,LP
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Telephone | 616-464-3424
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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 | 6301013342
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License Number State | MI
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