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General NPI Number Information
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NPI Number | 1205080934
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Entity Type | Individual
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Provider Name | KATHLEEN KREMSER NELSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1042 N MILFORD RD STE 205
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City | MILFORD
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State | MI
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Zip | 48381-5109
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Country | US
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Telephone | 248-889-5767
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Fax | 248-714-1480
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Provider Business Mailing Address
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Address Line | 1042 N MILFORD RD STE 205
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City | MILFORD
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State | MI
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Zip | 48381-5109
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Country | US
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Telephone | 248-889-5767
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Fax | 248-714-1480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301008117
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License Number State | MI
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