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General NPI Number Information
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NPI Number | 1326705294
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Entity Type | Organization
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Legal Business Name | RIVER JOURNEY MEMORY CLINIC
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 28284 62ND AVE
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City | LAWTON
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State | MI
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Zip | 49065-5613
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Country | US
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Telephone | 269-547-7630
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Fax | 269-225-0607
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Provider Business Mailing Address
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Address Line | 28284 62ND AVE
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City | LAWTON
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State | MI
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Zip | 49065-5613
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Country | US
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Telephone | 269-547-7630
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Fax | 269-225-0607
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Authorized Official
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Title or Position | NP/OWNER
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Name | LISA WOODRUFF
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Credential | NP
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Telephone | 269-547-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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