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General NPI Number Information
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NPI Number | 1649713819
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Entity Type | Organization
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Legal Business Name | WESTERN MICHIGAN UNIVERSITY PSYCHOLOGICAL ASSESSMENT AND TREATMENT SER
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 1903 W MICHIGAN AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-5200
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Country | US
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Telephone | 269-387-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 W MICHIGAN AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-5200
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Country | US
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Telephone | 269-387-2208
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Fax |
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Authorized Official
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Title or Position | PROFESSOR
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Name | DR. STEPHANIE MARIE PETERSON
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Credential | PH.D.
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Telephone | 269-387-4479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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