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General NPI Number Information
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NPI Number | 1386995900
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Entity Type | Organization
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Legal Business Name | JANE L. SPIES-WERT, PH.D., P.C.
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 15 IONIA AVE SW SUITE 645
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4102
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Country | US
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Telephone | 616-965-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 15 IONIA AVE SW SUITE 645
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4102
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Country | US
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Telephone | 616-965-1805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANE L SPIES-WERT
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Credential | PH.D.
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Telephone | 616-965-1805
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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 | MI
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