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General NPI Number Information
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NPI Number | 1720502685
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Entity Type | Individual
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Provider Name | KELLY TOGGWEILER
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 10524 GRAND RIVER RD STE 100
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City | BRIGHTON
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State | MI
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Zip | 48116-9559
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Country | US
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Telephone | 810-225-3417
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Fax |
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Provider Business Mailing Address
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Address Line | 32523 WISCONSIN ST
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City | LIVONIA
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State | MI
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Zip | 48150-3717
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Country | US
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Telephone | 586-883-2169
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Fax |
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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 | 6301017132
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301017132
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362008020
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362008020
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License Number State | MI
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