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General NPI Number Information
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NPI Number | 1760787998
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Entity Type | Organization
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Legal Business Name | ROCKFORD PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 16 NORTH MONROE
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City | ROCKFORD
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State | MI
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Zip | 49341
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Country | US
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Telephone | 616-866-4830
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Fax | 616-866-4944
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Provider Business Mailing Address
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Address Line | 16 NORTH MONROE
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City | ROCKFORD
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State | MI
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Zip | 49341
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Country | US
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Telephone | 616-866-4830
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Fax | 616-866-4944
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER JON BIRKELAND
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Credential | PH.D.
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Telephone | 616-866-4830
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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 | 6301006087
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License Number State | MI
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